Healthcare Provider Details

I. General information

NPI: 1174905707
Provider Name (Legal Business Name): FOUNDATIONS FOR GROWING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2015
Last Update Date: 03/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N JACKSON ST SUITE A
MEDIA PA
19063-2561
US

IV. Provider business mailing address

600 N JACKSON ST SUITE A
MEDIA PA
19063-2561
US

V. Phone/Fax

Practice location:
  • Phone: 484-444-2285
  • Fax: 484-444-2295
Mailing address:
  • Phone: 484-444-2285
  • Fax: 484-444-2295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MS. HEATHER M HAGGERTY
Title or Position: CLINICAL DIRECTOR
Credential:
Phone: 484-194-8335