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General NPI Number Information
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NPI Number | 1750034963
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Entity Type | Organization
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Legal Business Name | FOUNDATIONS OF COMMUNITY LIVING LLC
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Dates
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Enumeration Date | 01/27/2022
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Last Update Date | 01/27/2022
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Provider Practice Location Address
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Address Line | 1221 ERIE AVE
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City | SHEBOYGAN
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State | WI
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Zip | 53081-3384
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Country | US
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Telephone | 920-912-7749
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Fax |
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Provider Business Mailing Address
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Address Line | 618 ROOSEVELT RD
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City | KOHLER
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State | WI
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Zip | 53044-1618
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Country | US
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Telephone | 920-912-7749
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. TARA P TAYLOR
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Credential | LPC
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Telephone | 920-912-7749
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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 |
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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 | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health 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 | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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