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General NPI Number Information
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NPI Number | 1649944117
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Entity Type | Organization
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Legal Business Name | FOUNDATION RECOVERY CENTER
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Dates
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Enumeration Date | 08/06/2021
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Last Update Date | 03/10/2022
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Provider Practice Location Address
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Address Line | 2419 SOUTHERN AVE
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City | SHREVEPORT
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State | LA
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Zip | 71104-2969
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Country | US
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Telephone | 318-227-1475
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Fax | 318-227-1472
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Provider Business Mailing Address
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Address Line | 2419 SOUTHERN AVE
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City | SHREVEPORT
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State | LA
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Zip | 71104-2969
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Country | US
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Telephone | 318-227-1475
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Fax | 318-227-1472
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. TARA T DUPREE
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Credential |
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Telephone | 318-716-9085
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QR0800X
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Taxonomy Name | Recovery Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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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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