Provider Demographics
NPI:1568601094
Name:ANGELIC COMMUNITY & FAMILY SERVICES OF FORSYTH COUNTY
Entity Type:Organization
Organization Name:ANGELIC COMMUNITY & FAMILY SERVICES OF FORSYTH COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-968-6100
Mailing Address - Street 1:200 CHARLOIS BLVD
Mailing Address - Street 2:STE 400
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-1536
Mailing Address - Country:US
Mailing Address - Phone:336-768-7372
Mailing Address - Fax:336-768-7374
Practice Address - Street 1:200 CHARLOIS BLVD
Practice Address - Street 2:STE 400
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-1536
Practice Address - Country:US
Practice Address - Phone:336-768-7372
Practice Address - Fax:336-768-7374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-06
Last Update Date:2009-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization