Basic Information
| Provider Information | |||||||||
| NPI: | 1225629660 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | FOCUS RESIDENTIAL GROUP, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 303 GERVAIS RD | ||||||||
| Address2: | |||||||||
| City: | FRANKLIN FURNACE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 456298742 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7402597000 | ||||||||
| FaxNumber: | 7402597003 | ||||||||
| Practice Location | |||||||||
| Address1: | 303 GERVAIS RD | ||||||||
| Address2: | |||||||||
| City: | FRANKLIN FURNACE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 456298742 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7402597000 | ||||||||
| FaxNumber: | 7402597003 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/28/2021 | ||||||||
| LastUpdateDate: | 01/28/2021 | ||||||||
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| AuthorizedOfficialLastName: | GIFFORD | ||||||||
| AuthorizedOfficialFirstName: | KELLY | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7402597000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 01/28/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.