NPIMap

Organization Active NPI

Ford Home

  • Community/Behavioral Health Agency
  • Jacksonville, NC
National Provider Identifier
1104005735
Registry record updated Sep 14, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
MHL 067-167 Issued in NC
Legal business name
FORD HOME
Practice address
311 Brentwood Ave
Jacksonville, NC 28540-5405
Phone
(910) 324-2787
Fax
(910) 324-2725
NPI assigned
Oct 31, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 14, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Oliver Ford
Title
Owner/President
Phone
(910) 381-0125

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X MHL 067-167 NC Primary

Addresses

Primary practice location

311 Brentwood Ave
Jacksonville, NC 28540-5405

Mailing address

PO Box 5182
Jacksonville, NC 28540-1182
Phone (910) 937-6000

Other identifiers 1

IdentifierTypeStateIssuer
MHL 067-167MedicaidNC

National Provider Directory

National Provider Directory
Tax ID family
Ford Home3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1193788800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1252886400000",
    "number": "1104005735",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5182",
            "city": "JACKSONVILLE",
            "state": "NC",
            "postal_code": "285401182",
            "telephone_number": "910-937-6000",
            "fax_number": "910-324-2725"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "311 BRENTWOOD AVE",
            "city": "JACKSONVILLE",
            "state": "NC",
            "postal_code": "285405405",
            "telephone_number": "910-324-2787",
            "fax_number": "910-324-2725"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORD HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-31",
        "last_updated": "2009-09-14",
        "status": "A",
        "authorized_official_last_name": "FORD",
        "authorized_official_first_name": "OLIVER",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "910-381-0125",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NC",
            "license": "MHL 067-167",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "MHL 067-167",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.