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General NPI Number Information
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NPI Number | 1457670044
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Entity Type | Organization
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Legal Business Name | P L FORD HOMES/INDIANA
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Dates
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Enumeration Date | 05/22/2010
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Last Update Date | 05/22/2010
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Provider Practice Location Address
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Address Line | 519 E 60TH AVE
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City | MERRILLVILLE
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State | IN
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Zip | 46410-3068
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Country | US
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Telephone | 219-427-0704
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Fax |
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Provider Business Mailing Address
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Address Line | 519 E 60TH AVE
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City | MERRILLVILLE
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State | IN
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Zip | 46410-3068
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Country | US
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Telephone | 219-427-0407
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Fax |
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | PAULA L FORD
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Credential |
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Telephone | 219-427-0407
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number | 200976520 A
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License Number State | IN
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