Organization
FORSYTH VILLAGE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JERRY CHAPMAN (OWNER)
(336) 661-0850
Entity
Organization
Contact information
Practice address
5100 LANSING DR, WINSTON SALEM, NC 27105-3115
(336) 661-0850
(336) 661-0945
Mailing address
PO BOX 11525, WINSTON SALEM, NC 27116-1525
(336) 661-0850
(336) 661-0945
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
HAL-034-002
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7804769
—
NC
Enumeration date
12/28/2006
Last updated
08/22/2020
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