Organization
FORD HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. OLIVER FORD (OWNER/PRESIDENT)
(910) 381-0125
Entity
Organization
Contact information
Practice address
311 BRENTWOOD AVE, JACKSONVILLE, NC 28540-5405
(910) 324-2787
(910) 324-2725
Mailing address
PO BOX 5182, JACKSONVILLE, NC 28540-1182
(910) 937-6000
(910) 324-2725
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
MHL 067-167
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
MHL 067-167
—
NC
Enumeration date
10/31/2007
Last updated
09/14/2009
Update your record
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