Provider Demographics
NPI:1508606427
Name:FORD, ARTREL KESHON
Entity type:Individual
Prefix:
First Name:ARTREL
Middle Name:KESHON
Last Name:FORD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:724 CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:RAVENNA
Mailing Address - State:OH
Mailing Address - Zip Code:44266-2332
Mailing Address - Country:US
Mailing Address - Phone:330-261-4180
Mailing Address - Fax:
Practice Address - Street 1:724 CLINTON ST
Practice Address - Street 2:
Practice Address - City:RAVENNA
Practice Address - State:OH
Practice Address - Zip Code:44266-2332
Practice Address - Country:US
Practice Address - Phone:330-261-4180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-29
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker