Provider Demographics
NPI:1063430809
Name:FORWARD CARE MANAGEMENT, INC.
Entity type:Organization
Organization Name:FORWARD CARE MANAGEMENT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:HAYES
Authorized Official - Last Name:AMUSAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-475-8873
Mailing Address - Street 1:PO BOX 393
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27261-0393
Mailing Address - Country:US
Mailing Address - Phone:336-475-8873
Mailing Address - Fax:336-475-8874
Practice Address - Street 1:1209 SHALIMAR DR
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-4598
Practice Address - Country:US
Practice Address - Phone:336-475-8873
Practice Address - Fax:336-475-8874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-041-591320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6603072Medicaid