Healthcare Provider Details

I. General information

NPI: 1427981661
Provider Name (Legal Business Name): TALAYA KEYOSHA FORD I
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2026
Last Update Date: 06/06/2026
Certification Date: 06/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 BROADUS ST
STURGIS MI
49091-1384
US

IV. Provider business mailing address

215 BROADUS ST
STURGIS MI
49091-1384
US

V. Phone/Fax

Practice location:
  • Phone: 877-659-4500
  • Fax: 888-972-3891
Mailing address:
  • Phone: 877-659-4500
  • Fax: 888-972-3891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: