Healthcare Provider Details

I. General information

NPI: 1063341980
Provider Name (Legal Business Name): THE FOUNDRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2026
Last Update Date: 05/16/2026
Certification Date: 05/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10809 PARRISH ST
MATTHEWS NC
28105-8936
US

IV. Provider business mailing address

10809 PARRISH ST
MATTHEWS NC
28105-8936
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 Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: DIANNE THOMAS
Title or Position: FOUNDER
Credential:
Phone: 267-721-0926