Provider Demographics
NPI:1841879145
Name:FOUNDATIONAL HEALTH RESTORATION, LLC
Entity type:Organization
Organization Name:FOUNDATIONAL HEALTH RESTORATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MELINDA-ANN
Authorized Official - Middle Name:B
Authorized Official - Last Name:ROTH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-833-8205
Mailing Address - Street 1:644 COCKEYS MILL RD
Mailing Address - Street 2:
Mailing Address - City:REISTERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21136-5116
Mailing Address - Country:US
Mailing Address - Phone:410-833-8205
Mailing Address - Fax:
Practice Address - Street 1:540 JERMOR LN STE A
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-6490
Practice Address - Country:US
Practice Address - Phone:443-300-6367
Practice Address - Fax:443-300-6367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-05
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty