Provider Demographics
NPI:1285732420
Name:FORDHAM INC.
Entity type:Organization
Organization Name:FORDHAM INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:SHELBOURNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-637-3337
Mailing Address - Street 1:9585 HIGHWAY 78
Mailing Address - Street 2:UNIT A
Mailing Address - City:LADSON
Mailing Address - State:SC
Mailing Address - Zip Code:29456-3925
Mailing Address - Country:US
Mailing Address - Phone:843-637-3337
Mailing Address - Fax:843-637-3338
Practice Address - Street 1:9585 HIGHWAY 78
Practice Address - Street 2:UNIT A
Practice Address - City:LADSON
Practice Address - State:SC
Practice Address - Zip Code:29456-3925
Practice Address - Country:US
Practice Address - Phone:843-637-3337
Practice Address - Fax:843-637-3338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC032 37693 7332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDE2437Medicaid
SC=========OtherBLUE CROSS BLUE SHEILD
SC=========OtherTRICARE
SCDE2437Medicaid