Organization
FORD HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. OLIVER WENDELL FORD LPN (PRESIDENT)
(910) 381-0125
Entity
Organization
Contact information
Practice address
510 COLLEGE ST, JACKSONVILLE, NC 28540-4706
(910) 937-6000
(910) 347-4001
Mailing address
PO BOX 5182, JACKSONVILLE, NC 28540-1182
(910) 937-6000
(910) 347-4001
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8301299
—
NC
05
—
8301299B
—
NC
Enumeration date
02/12/2007
Last updated
09/14/2009
Update your record
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