Healthcare Provider Details

I. General information

NPI: 1336759240
Provider Name (Legal Business Name): DEERICKA JANAY FORD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2020
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 GRAND AVE
SACRAMENTO CA
95838-3466
US

IV. Provider business mailing address

811 GRAND AVE
SACRAMENTO CA
95838-3466
US

V. Phone/Fax

Practice location:
  • Phone: 916-317-5323
  • Fax:
Mailing address:
  • Phone: 916-317-5323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: