NPIMap

Organization Active NPI

Wake Forest University Health Sciences

Doing business as Amos Cottage Therapeutic Day Program

  • Community/Behavioral Health Agency
  • Winston Salem, NC
National Provider Identifier
1093016800
Registry record updated Nov 10, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
MHL034159 Issued in NC
Legal business name
WAKE FOREST UNIVERSITY HEALTH SCIENCES
Doing business as
Amos Cottage Therapeutic Day Program
Practice address
3325 Silas Creek Pkwy
Winston Salem, NC 27103-3013
Phone
(336) 713-7443
Fax
(336) 713-7850
NPI assigned
Nov 10, 2010
Last updated
Nov 10, 2010By the provider in NPPES
Organization subpart
Yes
Parent organization
WAKE FOREST UNIVERSITY HEALTH SCIENCESAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 10, 2010

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

Authorized official

Name
Dr. William B. Applegate, MD
Title
President
Phone
(336) 716-4424

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X MHL034159 NC Primary

Addresses

Primary practice location

3325 Silas Creek Pkwy
Winston Salem, NC 27103-3013

Mailing address

3325 Silas Creek Pkwy
Winston Salem, NC 27103-3013
Phone (336) 713-7443

Other identifiers 2

IdentifierTypeStateIssuer
8301291MedicaidNC
00391OtherNCBCBS

Other names 1

  • Amos Cottage Therapeutic Day Program Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Brenner Fit45 organizations share this tax ID, including this one
Part of
Brenner Fit

Other organizations with this tax ID 44

Organizations that report the same tax identification number in the National Provider Directory.

View all 44

NPI Registry JSON

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

{
    "created_epoch": "1289347200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1289347200000",
    "number": "1093016800",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3325 SILAS CREEK PKWY",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271033013",
            "telephone_number": "336-713-7443",
            "fax_number": "336-713-7850"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3325 SILAS CREEK PKWY",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271033013",
            "telephone_number": "336-713-7443",
            "fax_number": "336-713-7850"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAKE FOREST UNIVERSITY HEALTH SCIENCES",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WAKE FOREST UNIVERSITY HEALTH SCIENCES",
        "enumeration_date": "2010-11-10",
        "last_updated": "2010-11-10",
        "status": "A",
        "authorized_official_last_name": "APPLEGATE",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "B.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "336-716-4424",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NC",
            "license": "MHL034159",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8301291",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "00391",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Amos Cottage Therapeutic Day Program",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Winston Salem, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2010; 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.