Healthcare Provider Details

I. General information

NPI: 1417865684
Provider Name (Legal Business Name): THE FOUNDRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10809 PARRISH ST APT 215
MATTHEWS NC
28105-8939
US

IV. Provider business mailing address

2217 MATTHEWS TOWNSHIP PKWY STE D
MATTHEWS NC
28105-4819
US

V. Phone/Fax

Practice location:
  • Phone: 267-721-0926
  • Fax:
Mailing address:
  • Phone: 267-721-0926
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name: MS. DIANNE F THOMAS
Title or Position: FOUNDRY
Credential: ADEBONOJO
Phone: 267-721-0926