Healthcare Provider Details

I. General information

NPI: 1205260452
Provider Name (Legal Business Name): FOUNDATION STONE FAMILY SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2013
Last Update Date: 08/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6457 JONAH CLARKE ST
NORTH LAS VEGAS NV
89086-1343
US

IV. Provider business mailing address

6457 JONAH CLARKE ST
NORTH LAS VEGAS NV
89086-1343
US

V. Phone/Fax

Practice location:
  • Phone: 702-406-7960
  • Fax:
Mailing address:
  • Phone: 702-406-7960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number State

VIII. Authorized Official

Name: LESHAY HARRIS
Title or Position: CEO
Credential:
Phone: 702-406-7960