Provider Demographics
NPI:1679699565
Name:FOSTER'S CARE FACILITY, LLC
Entity Type:Organization
Organization Name:FOSTER'S CARE FACILITY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:FOSTER
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:WILKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MS EDU, QP
Authorized Official - Phone:336-885-0602
Mailing Address - Street 1:4201 BERWYN CT
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-7883
Mailing Address - Country:US
Mailing Address - Phone:336-601-1692
Mailing Address - Fax:336-855-0603
Practice Address - Street 1:213 LINDSAY ST
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-4868
Practice Address - Country:US
Practice Address - Phone:336-855-0602
Practice Address - Fax:336-855-0603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3409533OtherCAP PROVIDER ID