MEDICARE: FOUNDATION CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251F00000X	Home Infusion Agency
2	332B00000X	Durable Medical Equipment & Medical Supplies	2004013283	MO
3	3336H0001X	Home Infusion Therapy Pharmacy
4	333600000X	Pharmacy	2004013283	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	2172192	OTHER	PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205831963
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOUNDATION CARE LLC

Provider Business Mailing Address
First Line	:	PO BOX 955362
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63195-5362
Country	:	US
Telephone Number	:	855-422-2742
Fax Number	:	866-834-8523

Provider Business Practice Location Address
First Line	:	111 CHESTERFIELD INDUSTRIAL BLVD STE 115
Second Line	:
City	:	CHESTERFIELD
State	:	MO
Zip	:	63005-1219
Country	:	US
Telephone Number	:	877-291-1122
Fax Number	:	877-291-1155

Authorized Official
Title or Position	:	PRESIDENT, DIRECTOR
Name	:	JESSICA DAWN CICCOLELLA-KAHL
Credential	:
Telephone Number	:	800-511-5144

Provider Enumeration Date	:	06/17/2005
Last Update Date	:	05/22/2024

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Directions to “FOUNDATION CARE LLC ” Practice Location

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