Healthcare Provider Details

I. General information

NPI: 1144931601
Provider Name (Legal Business Name): FOSTERING COMMUNITIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2022
Last Update Date: 12/06/2022
Certification Date: 12/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

836 S SUBURBAN AVE
SPRINGFIELD MO
65802-6774
US

IV. Provider business mailing address

3871 S SUBURBAN
SPRINGFIELD MO
65807
US

V. Phone/Fax

Practice location:
  • Phone: 417-658-5409
  • Fax:
Mailing address:
  • Phone: 417-658-5408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. GENER ESTRADA GARCIA
Title or Position: CEO, CHIEF EXECUTIVE OFFICER
Credential: MS, LPC
Phone: 417-658-5409