Organization
FOREVER YOUNG GROUP CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JERRY FLOOD QP, BA (EXECUTIVE DIRECTOR)
(910) 864-9148
Entity
Organization
Contact information
Practice address
351 WAGONER DR, STE 328, FAYETTEVILLE, NC 28303-4608
(910) 864-9148
(910) 864-2548
Mailing address
351 WAGONER DR, STE 328, FAYETTEVILLE, NC 28303-4608
(910) 864-9148
(910) 864-2548
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8301520
—
NC
Enumeration date
03/05/2007
Last updated
08/22/2020
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