Provider Demographics
NPI:1881883387
Name:FOUNDATIONS LC
Entity type:Organization
Organization Name:FOUNDATIONS LC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FISI
Authorized Official - Middle Name:MEIMUA
Authorized Official - Last Name:MOLENI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:801-654-0772
Mailing Address - Street 1:4601 W 3245 S
Mailing Address - Street 2:
Mailing Address - City:WEST VALLEY
Mailing Address - State:UT
Mailing Address - Zip Code:84120-1523
Mailing Address - Country:US
Mailing Address - Phone:801-654-0772
Mailing Address - Fax:
Practice Address - Street 1:4601 W 3245 S
Practice Address - Street 2:
Practice Address - City:WEST VALLEY
Practice Address - State:UT
Practice Address - Zip Code:84120-1523
Practice Address - Country:US
Practice Address - Phone:801-654-0772
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-20
Last Update Date:2007-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5843697320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness