Healthcare Provider Details

I. General information

NPI: 1114984812
Provider Name (Legal Business Name): THOMPSON CHILD & FAMILY FOCUS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 07/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 KINGS MOUNTAIN ST
YORK SC
29745-1131
US

IV. Provider business mailing address

6800 SAINT PETERS LN
MATTHEWS NC
28105-8458
US

V. Phone/Fax

Practice location:
  • Phone: 803-684-4011
  • Fax: 803-684-8002
Mailing address:
  • Phone: 704-536-0375
  • Fax: 704-531-9266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MARCO RICARDO TOMAT
Title or Position: CEO
Credential:
Phone: 704-644-4347