Basic Information
| Provider Information | |||||||||
| NPI: | 1891857033 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CARE FOCUS, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7227 LEE DEFOREST RD | ||||||||
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| City: | COLUMBIA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210463236 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 4051 S MEMORIAL DR | ||||||||
| Address2: | |||||||||
| City: | WINTERVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 285907873 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2526410064 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/14/2006 | ||||||||
| LastUpdateDate: | 07/27/2007 | ||||||||
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| AuthorizedOfficialLastName: | BRICKHOUSE | ||||||||
| AuthorizedOfficialFirstName: | DUANE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CONTROLLER | ||||||||
| AuthorizedOfficialTelephone: | 4109101500 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | N | Agencies | Community/Behavioral Health | 251X00000X | N | Agencies | Supports Brokerage | 251C00000X | N | Agencies | Day Training, Developmentally Disabled Services | 171M00000X | N | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Case Manager/Care Coordinator | 3747P1801X | N | 193200000X MULTI-SPECIALTY GROUP | Nursing Service Related Providers | Technician | Personal Care Attendant | 320800000X | N | Residential Treatment Facilities | Community Based Residential Treatment Facility, Mental Illness | 320900000X | N | Residential Treatment Facilities | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 322D00000X | N | Residential Treatment Facilities | Residential Treatment Facility, Emotionally Disturbed Children | 320600000X | Y | Residential Treatment Facilities | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities |
ID Information
| ID | Type | State | Issuer | Description | 3409169 | 05 | NC | MEDICAID | 7804571 | 05 | NC | MEDICAID | 7804570 | 05 | NC | MEDICAID | 7804569 | 05 | NC | MEDICAID | 8301078G | 05 | NC | MEDICAID | 8301078 | 05 | NC | MEDICAID | 8301078B | 05 | NC | MEDICAID | 8301077 | 05 | NC | MEDICAID | 8301077B | 05 | NC | MEDICAID |