Healthcare Provider Details

I. General information

NPI: 1962801548
Provider Name (Legal Business Name): FOCUS RESIDENTIAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2014
Last Update Date: 08/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 GERVAIS RD
FRANKLIN FURNACE OH
45629-8742
US

IV. Provider business mailing address

303 GERVAIS RD
FRANKLIN FURNACE OH
45629-8742
US

V. Phone/Fax

Practice location:
  • Phone: 740-259-7000
  • Fax: 740-259-7001
Mailing address:
  • Phone: 740-259-7000
  • Fax: 740-259-7001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number13721
License Number StateOH

VIII. Authorized Official

Name: KELLY K GIFFORD
Title or Position: OWNER, EXECUTIVE DIRECTOR
Credential: RN
Phone: 740-259-7000