Healthcare Provider Details

I. General information

NPI: 1063430809
Provider Name (Legal Business Name): FORWARD CARE MANAGEMENT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1209 SHALIMAR DR
HIGH POINT NC
27262-4598
US

IV. Provider business mailing address

PO BOX 393
HIGH POINT NC
27261-0393
US

V. Phone/Fax

Practice location:
  • Phone: 336-475-8873
  • Fax: 336-475-8874
Mailing address:
  • Phone: 336-475-8873
  • Fax: 336-475-8874

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License NumberMHL-041-591
License Number StateNC

VIII. Authorized Official

Name: MRS. TERESA HAYES AMUSAN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 336-475-8873