MEDICARE: FOUNDATIONS HEALTH CENTERS

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	2083A0300X	Addiction Medicine (Preventive Medicine) Physician

General Provider Information

NPI Number	:	1851258776
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOUNDATIONS HEALTH CENTERS

Provider Business Mailing Address
First Line	:	1501 ROBERT J CONLAN BLVD NE STE 7
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32905-3559
Country	:	US
Telephone Number	:	321-479-4083
Fax Number	:	321-294-5036

Provider Business Practice Location Address
First Line	:	1501 ROBERT J CONLAN BLVD NE STE 7
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32905-3559
Country	:	US
Telephone Number	:	321-479-4083
Fax Number	:	321-294-5036

Authorized Official
Title or Position	:	OWNER, CEO
Name	:	DR. CHRISTAL DICKUN
Credential	:	MD
Telephone Number	:	860-204-1200

Provider Enumeration Date	:	01/05/2026
Last Update Date	:	01/05/2026

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