Healthcare Provider Details

I. General information

NPI: 1487799367
Provider Name (Legal Business Name): FOSTER'S CARE FACILITY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 11/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 HAMILTON PL STE 107
HIGH POINT NC
27262-4868
US

IV. Provider business mailing address

593 HUGH PATRICK COURT
GREENSBORO NC
27455
US

V. Phone/Fax

Practice location:
  • Phone: 336-885-0602
  • Fax: 336-885-0603
Mailing address:
  • Phone: 336-601-1692
  • Fax: 336-885-0603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberMHL041-979
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. FOSTER LEE WILKINS
Title or Position: EXECUTIVE DIRECTOR
Credential: QP, MS. EDU
Phone: 336-885-0602