Organization
FOREVER YOUNG GROUP CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JERRY LORENZO FLOOD BA (DIRECTOR)
(910) 527-0258
Entity
Organization
Contact information
Practice address
6121 HILCO DR, FAYETTEVILLE, NC 28314-2024
(910) 527-0258
(910) 864-2548
Mailing address
1133 CHESTNUT WOOD DR, FAYETTEVILLE, NC 28314-1890
(910) 527-0258
(910) 864-2548
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
MHL026562
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6604010
—
NC
Enumeration date
02/01/2007
Last updated
08/22/2020
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