Healthcare Provider Details

I. General information

NPI: 1962366104
Provider Name (Legal Business Name): U1ST FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3118 WILLIAMSBURG ST NW
WARREN OH
44485-2255
US

IV. Provider business mailing address

3118 WILLIAMSBURG ST NW
WARREN OH
44485-2255
US

V. Phone/Fax

Practice location:
  • Phone: 330-647-9792
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: EBONIE BOURGOIN
Title or Position: FOUNDER
Credential:
Phone: 330-647-9792