Foundation of Love for Youth, LLC (Fly House)

Primary specialty

Case Management AgencyTaxonomy code 251B00000X

Legal business name

FOUNDATION OF LOVE FOR YOUTH, LLC (FLY HOUSE)

Practice address

850 Oak St
Columbus, OH 43205-1113

Phone

(614) 429-3843

Fax

(614) 675-7537

NPI assigned

Nov 27, 2021

Last updated

Nov 27, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Tyra Nicole Martin, LMSW, CDCA, CPLCNPI 1538802640

Title

Social Worker

Phone

(614) 598-9891

Specialties & licenses 6

Addresses

Other identifiers 1

Electronic endpoints 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Tyra Nicole Martin, LSW

  • Social Worker
  • Newark, OH
  • NPI 1538802640
  NPD Authorized official

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

{
    "created_epoch": "1637971200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1637971200000",
    "number": "1669139572",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 992",
            "city": "REYNOLDSBURG",
            "state": "OH",
            "postal_code": "430680992",
            "telephone_number": "614-429-3843",
            "fax_number": "614-675-7537"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "850 OAK ST",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432051113",
            "telephone_number": "614-429-3843",
            "fax_number": "614-675-7537"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOUNDATION OF LOVE FOR YOUTH, LLC (FLY HOUSE)",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-11-27",
        "last_updated": "2021-11-27",
        "certification_date": "2021-11-27",
        "status": "A",
        "authorized_official_last_name": "MARTIN",
        "authorized_official_first_name": "TYRA",
        "authorized_official_middle_name": "NICOLE",
        "authorized_official_title_or_position": "SOCIAL WORKER",
        "authorized_official_telephone_number": "614-598-9891",
        "authorized_official_credential": "LMSW, CDCA, CPLC"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "251J00000X",
            "taxonomy_group": "",
            "desc": "Nursing Care",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "177F00000X",
            "taxonomy_group": "",
            "desc": "Lodging",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "174200000X",
            "taxonomy_group": "",
            "desc": "Meals",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1881064004",
            "state": "OH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "AVAST",
            "affiliation": "N",
            "endpointDescription": "Avast Business Antivirus Pro Plus",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "850 Oak St",
            "city": "Columbus",
            "state": "OH",
            "country_code": "US",
            "postal_code": "432051113",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Florence Foucher, BDS
• Maryam Fouladi, MD
• Ann Elizabeth Foulk, RN
• Lisa Marie Foulk, PSY.D.
• Jeffrey Todd Foulke, RN
• Foundation Youth Intervention
• Foundations Group Recovery Ohio LLC
• Fountain Community Healthcare Services, LLC
• Fountain Healthcare LLC
• Lemont Anthony Fountain

• Case Management Agency in Columbus, OH
• Providers in Columbus, OH by specialty
• Case Management Agency in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2021; 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.