Provider Demographics
NPI:1922986082
Name:FOUNDATION LIVING
Entity type:Organization
Organization Name:FOUNDATION LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:
Authorized Official - Last Name:DOUGLAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-326-3484
Mailing Address - Street 1:1804 LIBERTY PL
Mailing Address - Street 2:
Mailing Address - City:SICKLERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08081-5706
Mailing Address - Country:US
Mailing Address - Phone:609-326-3484
Mailing Address - Fax:
Practice Address - Street 1:1804 LIBERTY PL
Practice Address - Street 2:
Practice Address - City:SICKLERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08081-5706
Practice Address - Country:US
Practice Address - Phone:804-980-5916
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-25
Last Update Date:2025-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No171W00000XOther Service ProvidersContractorGroup - Multi-Specialty
No251V00000XAgenciesVoluntary or Charitable