Provider Demographics
NPI:1306496716
Name:FOUST, JACOB ROSS
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:ROSS
Last Name:FOUST
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2346 S DEVINNEY ST
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-4806
Mailing Address - Country:US
Mailing Address - Phone:303-324-6845
Mailing Address - Fax:
Practice Address - Street 1:2346 S DEVINNEY ST
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-4806
Practice Address - Country:US
Practice Address - Phone:303-324-6845
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-17
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide