Provider Demographics
NPI:1881741593
Name:FOUNDATION 2, INC
Entity type:Organization
Organization Name:FOUNDATION 2, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GILBAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:319-362-1170
Mailing Address - Street 1:1714 JOHNSON AVE NW
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52405-4865
Mailing Address - Country:US
Mailing Address - Phone:319-362-1170
Mailing Address - Fax:319-297-7406
Practice Address - Street 1:1714 JOHNSON AVE NW
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52405-4865
Practice Address - Country:US
Practice Address - Phone:319-362-1170
Practice Address - Fax:319-297-7406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1103135261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1103135Medicaid