Provider Demographics
NPI:1184506008
Name:COREBRIDGE 17 FOUNDATION, INC.
Entity type:Organization
Organization Name:COREBRIDGE 17 FOUNDATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHANEL
Authorized Official - Middle Name:
Authorized Official - Last Name:JEANTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-592-5065
Mailing Address - Street 1:6047 KIMBERLY BLVD STE N
Mailing Address - Street 2:
Mailing Address - City:NORTH LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33068-2820
Mailing Address - Country:US
Mailing Address - Phone:954-547-4346
Mailing Address - Fax:
Practice Address - Street 1:6047 KIMBERLY BLVD STE N
Practice Address - Street 2:
Practice Address - City:NORTH LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33068-2820
Practice Address - Country:US
Practice Address - Phone:954-592-5065
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-22
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No251B00000XAgenciesCase Management
No251V00000XAgenciesVoluntary or Charitable