Provider Demographics
NPI:1689794786
Name:DOGWOOD FCH
Entity Type:Organization
Organization Name:DOGWOOD FCH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADM.
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOSIE
Authorized Official - Middle Name:E
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-723-8456
Mailing Address - Street 1:1317 HATTIE AVE
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27101-1843
Mailing Address - Country:US
Mailing Address - Phone:336-723-8456
Mailing Address - Fax:
Practice Address - Street 1:1317 HATTIE AVE
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27101-1843
Practice Address - Country:US
Practice Address - Phone:336-723-8456
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility