Healthcare Provider Details

I. General information

NPI: 1982732269
Provider Name (Legal Business Name): SCHOOL HEALTH ALLIANCE FOR FORSYTH COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 10/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4555 OGBURN AVE
WINSTON SALEM NC
27105-2726
US

IV. Provider business mailing address

MEDICAL CENTER BLVD WFBH-SCHOOL HEALTH ALLIANCE
WINSTON SALEM NC
27157-0001
US

V. Phone/Fax

Practice location:
  • Phone: 336-703-4273
  • Fax: 336-661-4954
Mailing address:
  • Phone: 336-713-7188
  • Fax: 336-713-7183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. TRACY BRADSHAW
Title or Position: OFFICE MANAGER
Credential:
Phone: 336-713-7188