Provider Demographics
NPI:1194428581
Name:FOUNDATION FOR DIGNITY CARE LLC
Entity type:Organization
Organization Name:FOUNDATION FOR DIGNITY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-FOUNDER & ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KADIATU
Authorized Official - Middle Name:
Authorized Official - Last Name:KOROMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-512-8447
Mailing Address - Street 1:7120 W SUNNYSLOPE LN
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85345-7287
Mailing Address - Country:US
Mailing Address - Phone:623-512-8447
Mailing Address - Fax:
Practice Address - Street 1:7120 W SUNNYSLOPE LN
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85345-7287
Practice Address - Country:US
Practice Address - Phone:623-512-8447
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-23
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness