Provider Demographics
NPI:1316130008
Name:FORD ADULT FOSTER CARE
Entity type:Organization
Organization Name:FORD ADULT FOSTER CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADIMISTRATOR/MANAGER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BIRDIA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE-LVN
Authorized Official - Phone:817-375-0358
Mailing Address - Street 1:4901 BEACON CT
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76017-6053
Mailing Address - Country:US
Mailing Address - Phone:817-375-0358
Mailing Address - Fax:817-453-2028
Practice Address - Street 1:4901 BEACON CT
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76017-6053
Practice Address - Country:US
Practice Address - Phone:817-375-0358
Practice Address - Fax:817-453-2028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-25
Last Update Date:2007-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home