MEDICARE: FOUNDATION HEALTH SYSTEMS CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	NH0423	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619974177
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOUNDATION HEALTH SYSTEMS CORP

Provider Business Mailing Address
First Line	:	5755 SHATTALON DRIVE
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27105-1332
Country	:	US
Telephone Number	:	336-767-2750
Fax Number	:	336-767-3862

Provider Business Practice Location Address
First Line	:	5755 SHATTALON DRIVE
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27105-1332
Country	:	US
Telephone Number	:	336-767-2750
Fax Number	:	336-767-3862

Authorized Official
Title or Position	:	EVP CFO
Name	:	FRED M. HARGETT
Credential	:
Telephone Number	:	704-384-5184

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	10/26/2010

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