Individual
CALVEINA FORDE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
538 COUNTRY LAKE DR, MCDONOUGH, GA 30252-2683
(917) 500-3402
Mailing address
11338 208TH ST, QUEENS VILLAGE, NY 11429-2208
(917) 500-3402
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
—
Other
Enumeration date
09/10/2020
Last updated
09/10/2020
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