Provider Demographics
NPI:1033619192
Name:SANFORD, ORLANDO BRICKELY JR (PERSONAL CARE ATTEND)
Entity Type:Individual
Prefix:MR
First Name:ORLANDO
Middle Name:BRICKELY
Last Name:SANFORD
Suffix:JR
Gender:M
Credentials:PERSONAL CARE ATTEND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 S RACE ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45506-1444
Mailing Address - Country:US
Mailing Address - Phone:314-269-3695
Mailing Address - Fax:
Practice Address - Street 1:232 S RACE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45506-1444
Practice Address - Country:US
Practice Address - Phone:314-269-3695
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-15
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0240624Medicaid