Basic Information
Provider Information | |||||||||
NPI: | 1285797977 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | CARE FOCUS, INC. | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 7227 LEE DEFOREST RD | ||||||||
Address2: |   | ||||||||
City: | COLUMBIA | ||||||||
State: | MD | ||||||||
PostalCode: | 210463236 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: |   | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 1269 TUNNEL RD | ||||||||
Address2: | SUITE E | ||||||||
City: | ASHEVILLE | ||||||||
State: | NC | ||||||||
PostalCode: | 288055100 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8282994388 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/18/2006 | ||||||||
LastUpdateDate: | 08/22/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | BRICKHOUSE | ||||||||
AuthorizedOfficialFirstName: | DUANE | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | CONTROLLER | ||||||||
AuthorizedOfficialTelephone: | 4109101500 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 320600000X |   |   | X |   | Residential Treatment Facilities | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities |   | 251S00000X |   |   | X |   | Agencies | Community/Behavioral Health |   | 251X00000X |   |   | X |   | Agencies | Supports Brokerage |   | 251C00000X |   |   | X |   | Agencies | Day Training, Developmentally Disabled Services |   | 322D00000X |   |   | X |   | Residential Treatment Facilities | Residential Treatment Facility, Emotionally Disturbed Children |   | 320900000X |   |   | X |   | Residential Treatment Facilities | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities |   | 320800000X |   |   | X |   | Residential Treatment Facilities | Community Based Residential Treatment Facility, Mental Illness |   | 171M00000X |   |   | X | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Case Manager/Care Coordinator |   | 3747P1801X |   |   | X | 193200000X MULTI-SPECIALTY GROUP | Nursing Service Related Providers | Technician | Personal Care Attendant |
ID Information
ID | Type | State | Issuer | Description | 8300662 | 05 | NC |   | MEDICAID | 3409169 | 05 | NC |   | MEDICAID | 8300501B | 05 | NC |   | MEDICAID | 8300662B | 05 | NC |   | MEDICAID | 8300501 | 05 | NC |   | MEDICAID |