MEDICARE: FOUNDATIONS RECOVERY CENTER 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	261QM0850X	Adult Mental Health Clinic/Center
2	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1336960517
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOUNDATIONS RECOVERY CENTER LLC

Provider Business Mailing Address
First Line	:	17555 VENTURA BLVD STE 201
Second Line	:
City	:	ENCINO
State	:	CA
Zip	:	91316-3890
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	17555 VENTURA BLVD STE 201
Second Line	:
City	:	ENCINO
State	:	CA
Zip	:	91316-3890
Country	:	US
Telephone Number	:	805-217-7358
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	BRANDON BOYD
Credential	:
Telephone Number	:	805-217-7358

Provider Enumeration Date	:	10/21/2024
Last Update Date	:	03/11/2026

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Directions to “FOUNDATIONS RECOVERY CENTER LLC ” Practice Location

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