Provider Demographics
NPI:1053670240
Name:FOR OUR CHILDREN'S ULTIMATE SUCCESS
Entity Type:Organization
Organization Name:FOR OUR CHILDREN'S ULTIMATE SUCCESS
Other - Org Name:F.O.C.U.S.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KARMEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FOWLKES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-254-4143
Mailing Address - Street 1:3530 WARRENSVILLE CENTER RD
Mailing Address - Street 2:101D
Mailing Address - City:SHAKER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5278
Mailing Address - Country:US
Mailing Address - Phone:216-254-4143
Mailing Address - Fax:
Practice Address - Street 1:3530 WARRENSVILLE CENTER RD
Practice Address - Street 2:101D
Practice Address - City:SHAKER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44122-5278
Practice Address - Country:US
Practice Address - Phone:216-254-4143
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-09
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1459780251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0059248Medicaid