Fosters House LLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

FOSTERS HOUSE LLC

Practice address

1844 E Dana Ave
Mesa, AZ 85204-1351

Phone

(480) 980-0648

NPI assigned

Oct 13, 2022

Organization subpart

No

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

Authorized official

Name

Mr. Andre Nicholas Miller

Title

Administrator

Phone

(480) 980-0648

Specialties & licenses 1

Addresses

Electronic endpoints 1

Locations

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

{
    "created_epoch": "1665619200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1665619200000",
    "number": "1861118663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1844 E DANA AVE",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852041351",
            "telephone_number": "480-980-0648"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1844 E DANA AVE",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852041351",
            "telephone_number": "480-980-0648"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOSTERS HOUSE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-13",
        "last_updated": "2022-10-13",
        "certification_date": "2022-10-13",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "ANDRE",
        "authorized_official_middle_name": "NICHOLAS",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "480-980-0648",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "andre.miller@fostershouse.org",
            "affiliation": "N",
            "endpointDescription": "Fosters House LLC",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Phone",
            "address_1": "701 E Main St Apt 309",
            "city": "Mesa",
            "state": "AZ",
            "country_code": "US",
            "postal_code": "852038880",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Marcus W Fossmeyer, DNP, PMHNP
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• Tia N. Foukas, DNP, FNP-C
• Foundation for Healing, LLC
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• Fountains of Hope Behavioral Health LLC

• Mental Health Clinic/Center (Including Community Mental Health Center) in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2022; 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.