Provider Demographics
NPI:1770624256
Name:FOUNDATIONS GROUP OF MN, INC
Entity type:Organization
Organization Name:FOUNDATIONS GROUP OF MN, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:ERIN
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-408-1433
Mailing Address - Street 1:PO BOX 247
Mailing Address - Street 2:
Mailing Address - City:STACY
Mailing Address - State:MN
Mailing Address - Zip Code:55079-0247
Mailing Address - Country:US
Mailing Address - Phone:651-408-1433
Mailing Address - Fax:651-408-1434
Practice Address - Street 1:31100 FOREST BLVD
Practice Address - Street 2:BLDG B
Practice Address - City:STACY
Practice Address - State:MN
Practice Address - Zip Code:55079-9247
Practice Address - Country:US
Practice Address - Phone:651-408-1433
Practice Address - Fax:651-408-1434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1041613-1-WS251E00000X
MN251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health