Provider Demographics
NPI:1942268651
Name:FOUNDATION HEALTH SYSTEMS CORP
Entity Type:Organization
Organization Name:FOUNDATION HEALTH SYSTEMS CORP
Other - Org Name:EDWIN H. MARTINAT COMPREHENSIVE OUTPATIENT REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXE.VP & CCO & ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:SALLYE
Authorized Official - Middle Name:
Authorized Official - Last Name:LINER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-718-2004
Mailing Address - Street 1:2000 FRONTIS PLAZA BLVD STE 200
Mailing Address - Street 2:(ATTN) FORSYTH MEDICAL GROUP
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-5616
Mailing Address - Country:US
Mailing Address - Phone:336-277-2435
Mailing Address - Fax:336-277-9275
Practice Address - Street 1:865 W LAKE DR
Practice Address - Street 2:DBA EDWIN H. MARTINAT
Practice Address - City:MOUNT AIRY
Practice Address - State:NC
Practice Address - Zip Code:27030-2157
Practice Address - Country:US
Practice Address - Phone:336-719-6165
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Not Answered235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies