Provider Demographics
NPI:1942785340
Name:SUPPORT SYSTEMS OF FORSYTH COUNTY
Entity Type:Organization
Organization Name:SUPPORT SYSTEMS OF FORSYTH COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:K
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-695-3648
Mailing Address - Street 1:304 LINVILLE RIDGE CT APT 4
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27101-6246
Mailing Address - Country:US
Mailing Address - Phone:336-695-3648
Mailing Address - Fax:
Practice Address - Street 1:304 LINVILLE RIDGE CT APT 4
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27101-6246
Practice Address - Country:US
Practice Address - Phone:336-695-3648
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-01
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)