Active NPI
Forever Young Group Care LLC
- Community/Behavioral Health Agency
- Fayetteville, NC
National Provider Identifier
1780713834
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Behavioral Health Agency
- Legal business name
- FOREVER YOUNG GROUP CARE LLC
- Practice address
- 351 Wagoner Dr
Ste 328
Fayetteville, NC 28303-4608 - Phone
- (910) 864-9148
- Fax
- (910) 864-2548
- NPI assigned
- Mar 5, 2007
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Jerry Flood, QP, BA
- Title
- Executive Director
- Phone
- (910) 864-9148
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Behavioral Health Agency | 251S00000X | NC | Primary |
Addresses
Primary practice location
351 Wagoner Dr
Ste 328
Fayetteville, NC 28303-4608
Mailing address
351 Wagoner Dr
Ste 328
Fayetteville, NC 28303-4608
Phone (910) 864-9148
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8301520 | Medicaid | NC |
National Provider Directory
National Provider Directory- Tax ID family
- Forever Young Group Care
Other organizations with this tax ID 3
Organizations that report the same tax identification number in the National Provider Directory.
-
- Intellectual and/or Developmental Disabilities Residential Treatment Facility
- Fayetteville, NC
- NPI 1861530073
-
- Community/Behavioral Health Agency
- Wilson, NC
- NPI 1427245927
-
- Intellectual and/or Developmental Disabilities Residential Treatment Facility
- Fayetteville, NC
- NPI 1619014073
Locations
351 Wagoner Dr
Ste 328
Fayetteville, NC 28303
Phone (910) 864-9148
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173052800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1598054400000",
"number": "1780713834",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "351 WAGONER DR",
"address_2": "STE 328",
"city": "FAYETTEVILLE",
"state": "NC",
"postal_code": "283034608",
"telephone_number": "910-864-9148",
"fax_number": "910-864-2548"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "351 WAGONER DR",
"address_2": "STE 328",
"city": "FAYETTEVILLE",
"state": "NC",
"postal_code": "283034608",
"telephone_number": "910-864-9148",
"fax_number": "910-864-2548"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "FOREVER YOUNG GROUP CARE LLC",
"organizational_subpart": "NO",
"enumeration_date": "2007-03-05",
"last_updated": "2020-08-22",
"status": "A",
"authorized_official_last_name": "FLOOD",
"authorized_official_first_name": "JERRY",
"authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
"authorized_official_telephone_number": "910-864-9148",
"authorized_official_name_prefix": "Mr.",
"authorized_official_credential": "QP, BA"
},
"taxonomies": [
{
"code": "251S00000X",
"taxonomy_group": "",
"desc": "Community/Behavioral Health",
"state": "NC",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8301520",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fayetteville, NC
- Joycelyn Ann-Marie Forde
- Brandon James Fordham, PA-C
- Colby Edward Fordham, PT
- Kandis Danielle Fordham, PA-C
- Forever Young Group Care
- Forever Young Group Care, LLC
- Mary Rebecca Forgach, PA-C
- Forged by Fire Counseling Services, LLC (Mary Lynn Campbell)
- Shalita Shanta Forrest, RN
- Angela Ruff Forsyth, D.D.S.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.