Provider Demographics
NPI:1487799367
Name:FOSTER'S CARE FACILITY, LLC
Entity type:Organization
Organization Name:FOSTER'S CARE FACILITY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FOSTER
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:WILKINS
Authorized Official - Suffix:
Authorized Official - Credentials:QP, MS EDU
Authorized Official - Phone:336-885-0602
Mailing Address - Street 1:593 HUGH PATRICK COURT
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27455
Mailing Address - Country:US
Mailing Address - Phone:336-601-1692
Mailing Address - Fax:336-885-0603
Practice Address - Street 1:1320 HAMILTON PL STE 107
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-4868
Practice Address - Country:US
Practice Address - Phone:336-885-0602
Practice Address - Fax:336-885-0603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL041-979101YA0400X
251B00000X, 251S00000X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No251B00000XAgenciesCase ManagementGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8301410Medicaid