NPIMap

Organization Active NPI

Forever Young Group Care

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • Fayetteville, NC
National Provider Identifier
1861530073
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X
License
MHL026562 Issued in NC
Legal business name
FOREVER YOUNG GROUP CARE
Practice address
6121 Hilco Dr
Fayetteville, NC 28314-2024
Phone
(910) 527-0258
Fax
(910) 864-2548
NPI assigned
Feb 1, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Jerry Lorenzo Flood, BA
Title
Director
Phone
(910) 527-0258

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual and/or Developmental Disabilities Residential Treatment Facility 320600000X MHL026562 NC Primary

Addresses

Primary practice location

6121 Hilco Dr
Fayetteville, NC 28314-2024

Mailing address

1133 Chestnut Wood Dr
Fayetteville, NC 28314-1890
Phone (910) 527-0258

Other identifiers 1

IdentifierTypeStateIssuer
6604010MedicaidNC

National Provider Directory

National Provider Directory
Tax ID family
Forever Young Group Care4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

NPI Registry JSON

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

{
    "created_epoch": "1170288000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1861530073",
    "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": "6121 HILCO DR",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283142024",
            "telephone_number": "910-527-0258",
            "fax_number": "910-864-2548"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOREVER YOUNG GROUP CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-01",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "FLOOD",
        "authorized_official_first_name": "JERRY",
        "authorized_official_middle_name": "LORENZO",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "910-527-0258",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "BA"
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NC",
            "license": "MHL026562",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6604010",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, NC

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.

Verify at the official NPI Registry.