Healthcare Provider Details

I. General information

NPI: 1952215048
Provider Name (Legal Business Name): FOAMS FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19314 TILLMAN AVE
CARSON CA
90746-2430
US

IV. Provider business mailing address

19314 TILLMAN AVE
CARSON CA
90746-2430
US

V. Phone/Fax

Practice location:
  • Phone: 562-280-8000
  • Fax:
Mailing address:
  • Phone: 562-280-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. DONALD BROWN
Title or Position: CEO/PRESIDENT
Credential:
Phone: 562-280-8000