Healthcare Provider Details

I. General information

NPI: 1700261112
Provider Name (Legal Business Name): MR. JAWUAN FORD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2015
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 METRO PL N STE 300
DUBLIN OH
43017-5320
US

IV. Provider business mailing address

452 W MANHATTAN BLVD
TOLEDO OH
43608-1025
US

V. Phone/Fax

Practice location:
  • Phone: 855-289-1722
  • Fax:
Mailing address:
  • Phone: 419-973-3477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: