Healthcare Provider Details

I. General information

NPI: 1982434619
Provider Name (Legal Business Name): FOUNDATION HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2024
Last Update Date: 10/08/2024
Certification Date: 10/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1512 36TH ST
PARKERSBURG WV
26104-1942
US

IV. Provider business mailing address

1512 36TH ST
PARKERSBURG WV
26104-1942
US

V. Phone/Fax

Practice location:
  • Phone: 304-944-9346
  • Fax: 304-944-3054
Mailing address:
  • Phone: 304-944-9346
  • Fax: 304-944-3054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MEGAN RADCLIFF
Title or Position: OWNER, PROVIDER
Credential: FNP, PHMNP
Phone: 304-944-9346