| Family Foundation Center Llc | |
|
104 N Main St Union Bridge MD 21791-9102 | |
| (443) 541-4300 | |
| Not Available |
| Full Name | Family Foundation Center Llc |
|---|---|
| Speciality | Social Worker |
| Location | 104 N Main St, Union Bridge, Maryland |
| Authorized Official Name and Position | William John Bowman Ii (OWNER) |
| Authorized Official Contact | 4435414300 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Family Foundation Center Llc Po Box 591 Union Bridge MD 21791-0592 Ph: (443) 541-4300 | Family Foundation Center Llc 104 N Main St Union Bridge MD 21791-9102 Ph: (443) 541-4300 |
| NPI Number | 1659008522 |
|---|---|
| Provider Enumeration Date | 08/02/2022 |
| Last Update Date | 04/06/2023 |
| Certification Date | 04/06/2023 |
| Medicare PECOS PAC ID | 9032588538 |
|---|---|
| Medicare Enrollment ID | O20221205002738 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659008522 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Tiffany Nichole Ellison Masimore |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1346421716 PECOS PAC ID: 5193049278 Enrollment ID: I20150120001578 |
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