Healthcare Provider Details

I. General information

NPI: 1023572534
Provider Name (Legal Business Name): FOUNDATION RECOVERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2019
Last Update Date: 01/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 FREDERICK AVE STE 6
SAINT JOSEPH MO
64506-2637
US

IV. Provider business mailing address

2301 FREDERICK AVE STE 6
SAINT JOSEPH MO
64506-2637
US

V. Phone/Fax

Practice location:
  • Phone: 816-344-2328
  • Fax:
Mailing address:
  • Phone: 816-344-2328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: RITA M MILLER
Title or Position: DIRECTOR
Credential:
Phone: 816-646-1798