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General NPI Number Information
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NPI Number | 1932223617
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Entity Type | Organization
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Legal Business Name | FORD HOME
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 09/14/2009
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Provider Practice Location Address
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Address Line | 510 COLLEGE ST
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City | JACKSONVILLE
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State | NC
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Zip | 28540-4706
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Country | US
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Telephone | 910-937-6000
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Fax | 910-324-2725
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Provider Business Mailing Address
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Address Line | PO BOX 5182
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City | JACKSONVILLE
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State | NC
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Zip | 28540-1182
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Country | US
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Telephone | 910-937-6000
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Fax | 910-324-2725
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. OLIVER WENDELL FORD
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Credential | LPN
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Telephone | 910-381-0125
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | MHL-067-150
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License Number State | NC
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