NPI 1891079976

Montie Dale Ford, CDC

Practitioner Emotionally Disturbed Childrens' Residential Treatment Facility Fairbanks, AK

Practice location

Address: 1825 Marika Rd, Fairbanks, AK 99709-5521
Phone: (907) 474-0890
Fax: (907) 474-3621

Registered specialties

Emotionally Disturbed Childrens' Residential Treatment Facility Primary

Residential Treatment Facilities Taxonomy 322D00000X

Other Residential Treatment Facility, Emotionally Disturbed Children providers in Alaska →

Registry record

NPI: 1891079976
Entity type: Individual
Sex (as registered): Male
NPI issued: 6 Oct 2011
Record last updated: 6 Oct 2011

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.