1811044290 NPI number — FOCUS SUPPORT GROUP INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811044290 NPI number — FOCUS SUPPORT GROUP INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FOCUS SUPPORT GROUP INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1811044290
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
857 PLAZA LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOORESVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28115-9555
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-662-9179
Provider Business Mailing Address Fax Number:
704-663-1509

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
375 VIRGINIA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHINA GROVE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28023-8539
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-855-3853
Provider Business Practice Location Address Fax Number:
704-663-1509
Provider Enumeration Date:
01/05/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ONUOHA
Authorized Official First Name:
MONDAY
Authorized Official Middle Name:
CHINEYEZE
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
704-662-9179

Provider Taxonomy Codes

  • Taxonomy code: 320600000X , with the licence number:  MHL-080-141 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3409409 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".