MEDICARE: FOUNDATIONS GROUP OF MN, INC

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	251E00000X	Home Health Agency	1041613-1-WS	MN
2	251E00000X	Home Health Agency		MN

General Provider Information

NPI Number	:	1770624256
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOUNDATIONS GROUP OF MN, INC

Provider Business Mailing Address
First Line	:	PO BOX 247
Second Line	:
City	:	STACY
State	:	MN
Zip	:	55079-0247
Country	:	US
Telephone Number	:	651-408-1433
Fax Number	:	651-408-1434

Provider Business Practice Location Address
First Line	:	31100 FOREST BLVD
Second Line	:	BLDG B
City	:	STACY
State	:	MN
Zip	:	55079-9247
Country	:	US
Telephone Number	:	651-408-1433
Fax Number	:	651-408-1434

Authorized Official
Title or Position	:	PROGRAM DIRECTOR
Name	:	MRS. KIMBERLY ERIN SMITH
Credential	:
Telephone Number	:	651-408-1433

Provider Enumeration Date	:	02/09/2007
Last Update Date	:	08/22/2020

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