Healthcare Provider Details

I. General information

NPI: 1164504395
Provider Name (Legal Business Name): SOLID FOUNDATION FACILITIES INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 03/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 DUNDEE ST
WINDSOR NC
27983-6701
US

IV. Provider business mailing address

PO BOX 709 224 WARD ROAD
WINDSOR NC
27983-0709
US

V. Phone/Fax

Practice location:
  • Phone: 252-794-4800
  • Fax: 252-794-4747
Mailing address:
  • Phone: 252-794-2385
  • Fax: 252-794-1923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number626
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number626
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number626
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number626
License Number StateNC
# 5
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. R. VERNELL RODGERS
Title or Position: CEO PRESIDENT
Credential:
Phone: 252-794-2385