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MONTIE DALE FORD CDC 1 NPI 1891079976


NPI Information

NPI: 1891079976
Provider Name: MONTIE DALE FORD, CDC 1
Classification: Residential Treatment Facility, Emotionally Disturbed Children - 322D00000X
Entity Type: Individual
Address:
1825 MARIKA RD
FAIRBANKS, AK
ZIP 99709
Phone: (907) 474-0890
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Montie Dale Ford, CDC 1 is a residential treatment facility emotionally disturbed children in Fairbanks, AK. The provider is a residential facility that provides habilitation services and other care and treatment to children diagnosed with mental health illness, behavioral issues, and intellectual disabilities and are not able to live independently. Montie Dale Ford, CDC 1 NPI is 1891079976. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

1825 MARIKA RD
FAIRBANKS, AK
ZIP 99709-521
Phone: (907) 474-0890
Fax: (907) 474-3621

The enumeration date for this NPI number is 10/6/2011 and was last updated on 10/6/2011.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1322D00000XResidential Treatment Facility, Emotionally Disturbed ChildrenYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1DA3237MEDICAIDALASKA
2MH3237MEDICAIDALASKA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.