Healthcare Provider Details

I. General information

NPI: 1144049834
Provider Name (Legal Business Name): FOUNDATION HEALTH SYSTEMS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2024
Last Update Date: 10/09/2024
Certification Date: 10/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 SUTTON RD S
FORT MILL SC
29715-8439
US

IV. Provider business mailing address

PO BOX 601791
CHARLOTTE NC
28260-1791
US

V. Phone/Fax

Practice location:
  • Phone: 803-909-6447
  • Fax:
Mailing address:
  • Phone: 336-751-8003
  • Fax: 336-751-8030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateNULL

VIII. Authorized Official

Name: ERIN ELIZABETH BALL
Title or Position: MGR. REGIONAL REHAB SERVICES
Credential:
Phone: 704-316-4443