Provider Demographics
NPI:1770792533
Name:FOUNDATION MEDICAL STAFFING
Entity type:Organization
Organization Name:FOUNDATION MEDICAL STAFFING
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:TRAVELING OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:504-481-9800
Mailing Address - Street 1:416 W. 15TH BULIDING 700
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013
Mailing Address - Country:US
Mailing Address - Phone:405-285-2868
Mailing Address - Fax:405-285-0367
Practice Address - Street 1:416 W 15TH ST
Practice Address - Street 2:BUILDING 700
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-3747
Practice Address - Country:US
Practice Address - Phone:405-285-2868
Practice Address - Fax:405-285-0367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA56007952314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility