Healthcare Provider Details

I. General information

NPI: 1811044290
Provider Name (Legal Business Name): FOCUS SUPPORT GROUP INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 VIRGINIA AVE
CHINA GROVE NC
28023-8539
US

IV. Provider business mailing address

857 PLAZA LN
MOORESVILLE NC
28115-9555
US

V. Phone/Fax

Practice location:
  • Phone: 704-855-3853
  • Fax: 704-663-1509
Mailing address:
  • Phone: 704-662-9179
  • Fax: 704-663-1509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License NumberMHL-080-141
License Number StateNC

VIII. Authorized Official

Name: MR. MONDAY CHINEYEZE ONUOHA
Title or Position: CEO
Credential:
Phone: 704-662-9179