MEDICARE: FOUNDATIONS 4 LIFE, 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	251S00000X	Community/Behavioral Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1457795833	OTHER	CO	PERSONAL NPI

General Provider Information

NPI Number	:	1982218343
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOUNDATIONS 4 LIFE, LLC

Provider Business Mailing Address
First Line	:	478 E SCENIC DR
Second Line	:
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81507-1588
Country	:	US
Telephone Number	:	970-589-1649
Fax Number	:	970-986-8036

Provider Business Practice Location Address
First Line	:	2956 NORTH AVE STE 6
Second Line	:
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81504-3919
Country	:	US
Telephone Number	:	970-589-1649
Fax Number	:	970-986-8036

Authorized Official
Title or Position	:	OWNER/THERAPIST
Name	:	MR. AARON JOSEPH JIMENEZ
Credential	:	M.A. LAC
Telephone Number	:	970-589-1649

Provider Enumeration Date	:	09/03/2020
Last Update Date	:	08/06/2025

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