Healthcare Provider Details

I. General information

NPI: 1245554625
Provider Name (Legal Business Name): DISTINCT FOCUS ON LIFE LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2010
Last Update Date: 03/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 N US HIGHWAY 69
HUNTINGTON TX
75949
US

IV. Provider business mailing address

PO BOX 155953
LUFKIN TX
75915-5953
US

V. Phone/Fax

Practice location:
  • Phone: 936-635-2114
  • Fax:
Mailing address:
  • Phone: 936-635-2114
  • Fax: 936-422-4667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. JERRY L LOPER JR.
Title or Position: CEO
Credential:
Phone: 936-422-4440