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General NPI Number Information
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NPI Number | 1336052901
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Entity Type | Organization
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Legal Business Name | FOUNDATIONS FOR LIFE SERVICES LLC
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Dates
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Enumeration Date | 09/24/2026
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Last Update Date | 09/24/2026
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Provider Practice Location Address
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Address Line | 1102 FARMER ST
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City | PETERSBURG
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State | VA
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Zip | 23803-3935
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Country | US
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Telephone | 804-901-3978
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Fax |
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Provider Business Mailing Address
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Address Line | 12437 CHESDIN LANDING DR
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City | CHESTERFIELD
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State | VA
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Zip | 23838-3229
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Country | US
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Telephone | 804-901-3978
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | GAYLE CANDISE NICHOLAS
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Credential |
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Telephone | 804-901-3978
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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