Healthcare Provider Details

I. General information

NPI: 1053598920
Provider Name (Legal Business Name): FOUNDATION HEALTH SYSTEMS CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2008
Last Update Date: 01/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 MOORE RD DBA EDWIN H. MARTINAT OUTPT COMP REHAB CTR -KING
KING NC
27021-8703
US

IV. Provider business mailing address

2000 FRONTIS PLAZA BLVD STE 102 NOVANT MEDICAL GROUP
WINSTON SALEM NC
27103-5616
US

V. Phone/Fax

Practice location:
  • Phone: 336-719-6165
  • Fax:
Mailing address:
  • Phone: 336-277-2435
  • Fax: 336-277-9275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: SALLYE LINER
Title or Position: EXE. VP & CEO & ADMIN
Credential:
Phone: 336-718-2004