MEDICARE: FOUNDATIONS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency	NV20141602644	NV

General Provider Information

NPI Number	:	1326430406
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOUNDATIONS

Provider Business Mailing Address
First Line	:	3338 FICO AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89141-3512
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3338 FICO AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89141-3512
Country	:	US
Telephone Number	:	702-985-2218
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	UZURI UZURI
Credential	:
Telephone Number	:	702-985-2218

Provider Enumeration Date	:	02/25/2015
Last Update Date	:	02/25/2015

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Directions to “FOUNDATIONS ” Practice Location

Language	Start Address	Practice Location

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