Provider Demographics
NPI:1215672456
Name:FLOURISH FOUNDATION PROJECT
Entity type:Organization
Organization Name:FLOURISH FOUNDATION PROJECT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHANDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:SPATES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-661-3005
Mailing Address - Street 1:9107 CARROT PATCH DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28216-7103
Mailing Address - Country:US
Mailing Address - Phone:704-661-3005
Mailing Address - Fax:
Practice Address - Street 1:9107 CARROT PATCH DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28216-7103
Practice Address - Country:US
Practice Address - Phone:704-661-3005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-02
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No175T00000XOther Service ProvidersPeer SpecialistGroup - Multi-Specialty
No373H00000XNursing Service Related ProvidersDay Training/Habilitation SpecialistGroup - Multi-Specialty