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General NPI Number Information
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NPI Number | 1962801548
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Entity Type | Organization
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Legal Business Name | FOCUS RESIDENTIAL GROUP, LLC
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Dates
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Enumeration Date | 08/19/2014
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Last Update Date | 08/19/2014
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Provider Practice Location Address
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Address Line | 303 GERVAIS RD
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City | FRANKLIN FURNACE
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State | OH
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Zip | 45629-8742
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Country | US
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Telephone | 740-259-7000
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Fax | 740-259-7001
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Provider Business Mailing Address
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Address Line | 303 GERVAIS RD
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City | FRANKLIN FURNACE
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State | OH
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Zip | 45629-8742
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Country | US
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Telephone | 740-259-7000
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Fax | 740-259-7001
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Authorized Official
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Title or Position | OWNER, EXECUTIVE DIRECTOR
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Name | KELLY K GIFFORD
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Credential | RN
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Telephone | 740-259-7000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 13721
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License Number State | OH
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