Provider Demographics
NPI:1649944117
Name:FOUNDATION RECOVERY CENTER
Entity type:Organization
Organization Name:FOUNDATION RECOVERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TARA
Authorized Official - Middle Name:T
Authorized Official - Last Name:DUPREE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-716-9085
Mailing Address - Street 1:2419 SOUTHERN AVE
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71104-2969
Mailing Address - Country:US
Mailing Address - Phone:318-227-1475
Mailing Address - Fax:318-227-1472
Practice Address - Street 1:2419 SOUTHERN AVE
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71104-2969
Practice Address - Country:US
Practice Address - Phone:318-227-1475
Practice Address - Fax:318-227-1472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-06
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No261QR0800XAmbulatory Health Care FacilitiesClinic/CenterRecovery Care
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder