| Ford Home | |
|
311 Brentwood Ave Jacksonville NC 28540-5405 | |
| (910) 324-2787 | |
| (910) 324-2725 |
| Full Name | Ford Home |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 311 Brentwood Ave, Jacksonville, North Carolina |
| Authorized Official Name and Position | Oliver Ford (OWNER/PRESIDENT) |
| Authorized Official Contact | 9103810125 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ford Home Po Box 5182 Jacksonville NC 28540-1182 Ph: (910) 937-6000 | Ford Home 311 Brentwood Ave Jacksonville NC 28540-5405 Ph: (910) 324-2787 |
| NPI Number | 1104005735 |
|---|---|
| Provider Enumeration Date | 10/31/2007 |
| Last Update Date | 09/14/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104005735 | NPI | - | NPPES |
| MHL 067-167 | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | MHL 067-167 (North Carolina) | Primary |
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