1104931609 NPI number — FOCUS CARE HEALTH RESOURCES, INC

Table of content: (NPI 1104931609)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104931609 NPI number — FOCUS CARE HEALTH RESOURCES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FOCUS CARE HEALTH RESOURCES, 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:
6
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:
1104931609
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/07/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12900 FOSTER SUITE 400
Provider Second Line Business Mailing Address:
ATTN: LICENSING & CERTIFICATION DEPT.
Provider Business Mailing Address City Name:
OVERLAND PARK
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66062-2696
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-814-2800
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
251 WATERMERE DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTHLAKE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76092-8134
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-562-5408
Provider Business Practice Location Address Fax Number:
817-337-9171
Provider Enumeration Date:
08/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SCHWARTZ
Authorized Official First Name:
RUTH
Authorized Official Middle Name:
C.
Authorized Official Title or Position:
ASSISTANT SECRETARY
Authorized Official Telephone Number:
913-814-2288

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  007248 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000877700 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000024400 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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