Provider Demographics
NPI:1053626432
Name:MACKFORD HEALTH CARE AGENCY INC
Entity type:Organization
Organization Name:MACKFORD HEALTH CARE AGENCY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNIE
Authorized Official - Middle Name:MILDRED
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:404-551-1649
Mailing Address - Street 1:7910 PINEBUFF CT
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28311-9382
Mailing Address - Country:US
Mailing Address - Phone:910-485-4348
Mailing Address - Fax:
Practice Address - Street 1:3318 DIBBLE ST
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29118-0000
Practice Address - Country:US
Practice Address - Phone:910-485-4348
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-10
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health