Basic Information
| Provider Information | |||||||||
| NPI: | 1124171285 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FOCUS BEHAVIROAL HEALTH SERVICES, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3624 | ||||||||
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| City: | MORGANTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286803624 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8284398191 | ||||||||
| FaxNumber: | 8284392622 | ||||||||
| Practice Location | |||||||||
| Address1: | 2533 AIRPORT RD | ||||||||
| Address2: | |||||||||
| City: | MARION | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287524590 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286592500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/19/2007 | ||||||||
| LastUpdateDate: | 06/12/2017 | ||||||||
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| AuthorizedOfficialLastName: | DOUGLAS | ||||||||
| AuthorizedOfficialFirstName: | PAM | ||||||||
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| AuthorizedOfficialTitleorPosition: | NC DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8284398191 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 320800000X | MHL-059-018 | NC | Y | Residential Treatment Facilities | Community Based Residential Treatment Facility, Mental Illness |
ID Information
| ID | Type | State | Issuer | Description | 6603122 | 05 | NC | MEDICAID |