MEDICARE: SURE FOUNDATIONS, LLC

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	252Y00000X	Early Intervention Provider Agency	214061	VA

General Provider Information

NPI Number	:	1750698189
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SURE FOUNDATIONS, LLC

Provider Business Mailing Address
First Line	:	1210 MARSH ST
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23523-1767
Country	:	US
Telephone Number	:	757-237-0234
Fax Number	:

Provider Business Practice Location Address
First Line	:	1210 MARSH ST
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23523-1767
Country	:	US
Telephone Number	:	757-237-0234
Fax Number	:

Authorized Official
Title or Position	:	PROFESSIONAL
Name	:	MRS. ALBERTA REID
Credential	:	MSW, CFCS-HDFS
Telephone Number	:	757-237-0235

Provider Enumeration Date	:	09/07/2010
Last Update Date	:	09/07/2010

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