Healthcare Provider Details

I. General information

NPI: 1467729640
Provider Name (Legal Business Name): FOUNDATIONS FOR CHANGE PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2011
Last Update Date: 11/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3841 N 24TH ST
PHOENIX AZ
85016-6512
US

IV. Provider business mailing address

3841 N 24TH ST
PHOENIX AZ
85016-6512
US

V. Phone/Fax

Practice location:
  • Phone: 602-368-8311
  • Fax: 602-368-8318
Mailing address:
  • Phone: 602-368-8311
  • Fax: 602-368-8318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License NumberAP2472
License Number StateAZ

VIII. Authorized Official

Name: JEFFREY S EDELMAN
Title or Position: OWNER
Credential: N.P.
Phone: 602-368-8311