Healthcare Provider Details

I. General information

NPI: 1518023217
Provider Name (Legal Business Name): FORSYTH COUNTY DSS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 06/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

741 HIGHLAND AVE
WINSON SALEM NC
27101
US

IV. Provider business mailing address

741 HIGHLAND AVE
WINSTON SALEM NC
27101
US

V. Phone/Fax

Practice location:
  • Phone: 336-703-3408
  • Fax: 336-727-2850
Mailing address:
  • Phone: 336-703-3408
  • Fax: 336-727-2850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number StateNC

VIII. Authorized Official

Name: PAT READ
Title or Position: BUSINESS OFFICER
Credential: MBA/MHS
Phone: 336-703-3408