Provider Demographics
NPI:1770194763
Name:FOUNDATIONS FOR HEALTH, LLC
Entity type:Organization
Organization Name:FOUNDATIONS FOR HEALTH, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GWENDOLYN
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:ND, LAC
Authorized Official - Phone:503-975-3256
Mailing Address - Street 1:PO BOX 1716
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-0576
Mailing Address - Country:US
Mailing Address - Phone:503-673-1630
Mailing Address - Fax:503-673-8051
Practice Address - Street 1:12570 SW 69TH AVE STE 101
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-2552
Practice Address - Country:US
Practice Address - Phone:503-673-1630
Practice Address - Fax:503-673-8051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-12
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center