Healthcare Provider Details

I. General information

NPI: 1922986082
Provider Name (Legal Business Name): FOUNDATION LIVING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2025
Last Update Date: 09/09/2025
Certification Date: 09/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1804 LIBERTY PL
SICKLERVILLE NJ
08081-5706
US

IV. Provider business mailing address

1804 LIBERTY PL
SICKLERVILLE NJ
08081-5706
US

V. Phone/Fax

Practice location:
  • Phone: 804-980-5916
  • Fax:
Mailing address:
  • Phone: 609-326-3484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: BRANDON DOUGLAS
Title or Position: CEO
Credential:
Phone: 609-326-3484