Provider Demographics
NPI:1487298881
Name:FOUNDATION CARE LLC
Entity type:Organization
Organization Name:FOUNDATION CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:CICCOLELLA-KAHL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-511-5144
Mailing Address - Street 1:PO BOX 955362
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63195-5362
Mailing Address - Country:US
Mailing Address - Phone:855-422-2742
Mailing Address - Fax:866-834-8523
Practice Address - Street 1:111 CHESTERFIELD INDUSTRIAL BLVD STE 115
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63005-1219
Practice Address - Country:US
Practice Address - Phone:877-291-1122
Practice Address - Fax:877-291-1155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-30
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy