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General NPI Number Information
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NPI Number | 1891237244
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Entity Type | Organization
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Legal Business Name | FOUNDATION INTERVENTION SERVICES LLC
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Dates
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Enumeration Date | 11/15/2016
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Last Update Date | 02/27/2022
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Provider Practice Location Address
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Address Line | 4776 VIA BARI APT 6304
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City | LAKE WORTH
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State | FL
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Zip | 33463-6793
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Country | US
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Telephone | 954-326-2262
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Fax |
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Provider Business Mailing Address
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Address Line | 4776 VIA BARI APT 6304
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City | LAKE WORTH
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State | FL
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Zip | 33463-6793
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Country | US
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Telephone | 954-326-2262
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | RUSHELLE CAMPBELL
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Credential |
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Telephone | 954-326-2262
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State | FL
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