MEDICARE: MS. TREVIA FORD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator
2	106S00000X	Behavior Technician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043956196
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TREVIA FORD

Provider Business Mailing Address
First Line	:	GREEN APPLE HEALTH SERVICES LLC
Second Line	:	4717 E MCDOWELL RD
City	:	PHOENIX
State	:	AZ
Zip	:	85008
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	GREEN APPLE HEALTH SERVICES LLC
Second Line	:	4717 E MCDOWELL RD
City	:	PHOENIX
State	:	AZ
Zip	:	85008
Country	:	US
Telephone Number	:	602-683-4830
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2022
Last Update Date	:	05/11/2022

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