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General NPI Number Information
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NPI Number | 1457539785
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Entity Type | Organization
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Legal Business Name | FOUNDATION SERVICES GROUP, INC
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Dates
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Enumeration Date | 02/08/2008
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Last Update Date | 02/08/2008
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Provider Practice Location Address
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Address Line | 372 SW 1ST AVE
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City | ONTARIO
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State | OR
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Zip | 97914-2734
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Country | US
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Telephone | 541-881-1271
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Fax | 541-881-1256
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Provider Business Mailing Address
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Address Line | 372 SW 1ST AVE
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City | ONTARIO
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State | OR
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Zip | 97914-2734
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Country | US
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Telephone | 541-881-1271
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Fax | 541-881-1256
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. LINDA K. BURKS
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Credential | CADC II
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Telephone | 541-881-1271
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 48846299
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License Number State | OR
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