Forever Young Secured Community

Primary specialty

Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X

License

MHL047101 Issued in NC

Legal business name

FOREVER YOUNG SECURED COMMUNITY

Practice address

181 Bostic Rd
Raeford, NC 28376-6101

Phone

(910) 527-0258

Fax

(910) 864-2548

NPI assigned

Feb 1, 2007

Organization subpart

Yes

Parent organization

FOREVER YOUNG GROUP CARE LLCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Alma Jean Weston

Title

Onwer

Phone

(910) 527-0258

Specialties & licenses 1

Addresses

Other identifiers 1

Part of

Forever Young Group Care

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170288000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1365379200000",
    "number": "1073650446",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1133 CHESTNUT WOOD DR",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283141890",
            "telephone_number": "910-527-0258",
            "fax_number": "910-864-2548"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "181 BOSTIC RD",
            "city": "RAEFORD",
            "state": "NC",
            "postal_code": "283766101",
            "telephone_number": "910-527-0258",
            "fax_number": "910-864-2548"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOREVER YOUNG SECURED COMMUNITY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FOREVER YOUNG GROUP CARE LLC",
        "enumeration_date": "2007-02-01",
        "last_updated": "2013-04-08",
        "status": "A",
        "authorized_official_last_name": "WESTON",
        "authorized_official_first_name": "ALMA",
        "authorized_official_middle_name": "JEAN",
        "authorized_official_title_or_position": "ONWER",
        "authorized_official_telephone_number": "910-527-0258",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NC",
            "license": "MHL047101",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6604011",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Deborah Ann Fike, LCAS, CCS
• Firsthealth Dental Care Center
• Mary Fitzharris, MA
• FNG Entertainment, Inc. (Each One Reach Two)
• For Life Wellness,LLC
• Carol Davis Forte, LPCA
• Cory T Francis
• Lekishia Lorraine Freeman, : 106S00000X
• Jennifer Elizabeth Gaguzis, LCSW
• Gainey & Roverato Therapeutic Services

• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Raeford, NC
• Providers in Raeford, NC by specialty
• Intellectual and/or Developmental Disabilities Residential Treatment Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.