Stephanie R Forde

Primary specialty

Personal Care AttendantTaxonomy code 3747P1801X

Practice address

12379 Glimmer Way
Jacksonville, FL 32219-1867

Phone

(904) 314-7411

Fax

(904) 751-2200

NPI assigned

Jun 18, 2019

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other names 1

• Ms. Stephanie R Green Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Excel Beyond Reach Group Home and Support Services, Inc

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Jacksonville, FL
  • NPI 1902777022
  NPD Authorized official
• Excel Beyond Transportation

  • Non-emergency Medical Transport (VAN)
  • Jacksonville, FL
  • NPI 1114803186
  NPD (past) Authorized official

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

{
    "created_epoch": "1560816000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701043200000",
    "number": "1831759141",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12379 GLIMMER WAY",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322191867",
            "telephone_number": "904-314-7411",
            "fax_number": "904-751-2200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12379 GLIMMER WAY",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322191867",
            "telephone_number": "904-314-7411",
            "fax_number": "904-751-2200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORDE",
        "first_name": "STEPHANIE",
        "middle_name": "R",
        "name_prefix": "Mrs.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-06-18",
        "last_updated": "2023-11-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "374U00000X",
            "taxonomy_group": "",
            "desc": "Home Health Aide",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "385HR2060X",
            "taxonomy_group": "",
            "desc": "Respite Care, Respite Care, Intellectual and/or Developmental Disabilities, Child",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3747P1801X",
            "taxonomy_group": "",
            "desc": "Technician, Personal Care Attendant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Jacksonville",
            "affiliation": "Y",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "12379 Glimmer Way",
            "city": "Jacksonville",
            "state": "FL",
            "country_code": "US",
            "postal_code": "322191867",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "STEPHANIE",
            "last_name": "GREEN",
            "middle_name": "R",
            "prefix": "MS.",
            "credential": "STEPHANIE GREEN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Peggy P Ford, ND/N
• Regina Lynne Ford, M.ED.
• Ryan Edward Ford, PHARM.D.
• Thomasina Jacinta Ford
• Toni Ford
• Jajuan Mondreese Fordham
• Kimberly Wais Fore, LCSW
• Koleton Michael Forehand, MD
• Kathrine Marie Foreman, R.D., LD/N
• Ashley Ann Foret, MD

• Personal Care Attendant in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Personal Care Attendant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2023; 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.