Healthcare Provider Details

I. General information

NPI: 1619974177
Provider Name (Legal Business Name): FOUNDATION HEALTH SYSTEMS CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 10/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5755 SHATTALON DRIVE
WINSTON SALEM NC
27105-1332
US

IV. Provider business mailing address

5755 SHATTALON DRIVE
WINSTON SALEM NC
27105-1332
US

V. Phone/Fax

Practice location:
  • Phone: 336-767-2750
  • Fax: 336-767-3862
Mailing address:
  • Phone: 336-767-2750
  • Fax: 336-767-3862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH0423
License Number StateNC

VIII. Authorized Official

Name: FRED M. HARGETT
Title or Position: EVP CFO
Credential:
Phone: 704-384-5184