Provider Demographics
NPI:1972659829
Name:FORD, FANNIE JOYCE (SUPPORTIVE HOME CARE)
Entity type:Individual
Prefix:MRS
First Name:FANNIE
Middle Name:JOYCE
Last Name:FORD
Suffix:
Gender:F
Credentials:SUPPORTIVE HOME CARE
Other - Prefix:MRS
Other - First Name:FANNIE
Other - Middle Name:JOYCE
Other - Last Name:WILCOX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SUPPORTIVE HOME CARE
Mailing Address - Street 1:917 SUNRISE HILL DR
Mailing Address - Street 2:
Mailing Address - City:JUNCTION CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66441-3846
Mailing Address - Country:US
Mailing Address - Phone:785-238-6582
Mailing Address - Fax:
Practice Address - Street 1:917 SUNRISE HILL DR
Practice Address - Street 2:
Practice Address - City:JUNCTION CITY
Practice Address - State:KS
Practice Address - Zip Code:66441-3846
Practice Address - Country:US
Practice Address - Phone:785-238-6582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide