Provider Demographics
NPI:1801002290
Name:COMMUNITY CARE CENTER FOR FORSYTH COUNTY
Entity Type:Organization
Organization Name:COMMUNITY CARE CENTER FOR FORSYTH COUNTY
Other - Org Name:DOCTORS CARE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-760-1235
Mailing Address - Street 1:2135 NEW WALKERTOWN RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27101-3420
Mailing Address - Country:US
Mailing Address - Phone:336-723-7904
Mailing Address - Fax:336-723-4163
Practice Address - Street 1:2135 NEW WALKERTOWN RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27101-3420
Practice Address - Country:US
Practice Address - Phone:336-723-7904
Practice Address - Fax:336-723-4163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health