Provider Demographics
NPI:1215028246
Name:SPRINGWELL NETWORK, INC.
Entity Type:Organization
Organization Name:SPRINGWELL NETWORK, INC.
Other - Org Name:GROUP HOMES OF FORSYTH, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CHARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-831-1300
Mailing Address - Street 1:3820 NORTH PATTERSON AVENUE
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27105
Mailing Address - Country:US
Mailing Address - Phone:336-831-1300
Mailing Address - Fax:336-831-1314
Practice Address - Street 1:3830 EBERT STREET
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27127-5742
Practice Address - Country:US
Practice Address - Phone:336-785-2635
Practice Address - Fax:336-831-1314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2018-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-034-361251S00000X, 311ZA0620X, 320600000X
NCMHL034150320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No251S00000XAgenciesCommunity/Behavioral Health
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7804420Medicaid