Provider Demographics
NPI:1144017401
Name:FORD, DELDRICK LASHONE SR
Entity type:Individual
Prefix:
First Name:DELDRICK
Middle Name:LASHONE
Last Name:FORD
Suffix:SR
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 1:478 MAPLE CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:OH
Mailing Address - Zip Code:45246-1510
Mailing Address - Country:US
Mailing Address - Phone:312-880-8274
Mailing Address - Fax:312-880-8274
Practice Address - Street 1:478 MAPLE CIRCLE DR
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:OH
Practice Address - Zip Code:45246-1510
Practice Address - Country:US
Practice Address - Phone:312-880-8274
Practice Address - Fax:312-880-8274
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-21
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide