Healthcare Provider Details

I. General information

NPI: 1326136029
Provider Name (Legal Business Name): PERFECT FOUNDATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 06/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1419 COLLEGE ST SUITE A
OXFORD NC
27565-2578
US

IV. Provider business mailing address

PO BOX 1154
OXFORD NC
27565-1154
US

V. Phone/Fax

Practice location:
  • Phone: 919-693-3898
  • Fax: 919-693-5633
Mailing address:
  • Phone: 919-693-3898
  • Fax: 919-693-5633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: EURA HAYES
Title or Position: PRESIDENT CEO
Credential:
Phone: 919-693-3898