Provider Demographics
NPI:1306596762
Name:FORD, LISA GAYE
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:GAYE
Last Name:FORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1895 REDWOOD ST
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-3607
Mailing Address - Country:US
Mailing Address - Phone:614-902-9372
Mailing Address - Fax:
Practice Address - Street 1:1895 REDWOOD ST
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-3607
Practice Address - Country:US
Practice Address - Phone:614-902-9372
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-28
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care