Organization
LTC ACO PARTICIPANT 105, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JILL C FORD (DIR OF CRED / AUTHORIZED OFFICIAL)
(859) 291-4800
Entity
Organization
Contact information
Practice address
1700 PINE ST, NORRISTOWN, PA 19401-3040
(610) 237-7100
(610) 277-6239
Mailing address
PO BOX 639676, CINCINNATI, OH 45263-9676
(859) 291-4800
Taxonomy
Speciality
Code
Description
License number
State
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
—
—
Other
Enumeration date
01/29/2026
Last updated
01/29/2026
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