Ford, Montie Dale

Ford, Montie Dale is an sole proprietor health care provider with primary practice located at 1825 Marika Rd , Fairbanks AK 99709-5521. He recently has only one registered license in Residential Treatment Facilities / Residential Treatment Facility, Emotionally Disturbed Children, which is considered as his primary health care specialty. Ford, Montie Dale can be contacted via phone (907) 474-0890.

Contact Information

Primary practice address
1825 Marika Rd Fairbanks AK 99709-5521
Phone: (907) 474-0890
Fax: (907) 474-3621
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Residential Treatment Facilities / Residential Treatment Facility, Emotionally Disturbed Children 322D00000X

Profile Details

NPI number 1891079976
LBN Legal business name Ford, Montie Dale
Credentials CDC 1
Entity Individual
Sole proprietor 1 Yes
Enumeration date Oct 6th, 2011
Last updated Oct 6th, 2011 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

Request for update

Identifiers

StateTypeNumberIssuer
All States NPI 1891079976 NPPES
Alaska MEDICAID DA3237
Alaska MEDICAID MH3237

Popular Providers