Corebridge 17 Foundation, Inc.

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

COREBRIDGE 17 FOUNDATION, INC.

Practice address

6047 Kimberly Blvd Ste N
North Lauderdale, FL 33068-2820

Phone

(954) 592-5065

NPI assigned

Jul 22, 2025

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Manoushka Remogene

Title

Executive Director

Phone

(954) 592-5065

Specialties & licenses 4

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1753142400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1759449600000",
    "number": "1184506008",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6047 KIMBERLY BLVD STE N",
            "city": "NORTH LAUDERDALE",
            "state": "FL",
            "postal_code": "330682820",
            "telephone_number": "954-547-4346"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6047 KIMBERLY BLVD STE N",
            "city": "NORTH LAUDERDALE",
            "state": "FL",
            "postal_code": "330682820",
            "telephone_number": "954-592-5065"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COREBRIDGE 17 FOUNDATION, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-07-22",
        "last_updated": "2025-10-03",
        "certification_date": "2025-10-03",
        "status": "A",
        "authorized_official_last_name": "REMOGENE",
        "authorized_official_first_name": "MANOUSHKA",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "954-592-5065"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "251V00000X",
            "taxonomy_group": "",
            "desc": "Voluntary or Charitable",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.