Organization
FOUNDATIONS MEDICAL SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JONATHAN E WOLF (CEO)
(814) 940-0407
Entity
Organization
Contact information
Practice address
124 HOLLYWOOD DR, BANTAM COMMONS BUILDING 2, BUTLER, PA 16001-5600
(724) 431-2006
(724) 431-2003
Mailing address
160 HINDMAN RD, BUTLER, PA 16001-2417
(724) 431-2006
(724) 431-2003
Taxonomy
Speciality
Code
Description
License number
State
261QM2800X
Methadone Clinic
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
107034
STATE LICENSE
PA
Enumeration date
02/13/2007
Last updated
08/12/2021
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