Provider Demographics
NPI:1386043198
Name:DIRECT FOCUS 2 INC
Entity Type:Organization
Organization Name:DIRECT FOCUS 2 INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:RIVERS
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:336-997-5500
Mailing Address - Street 1:1056 W BANK ST
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27101-4914
Mailing Address - Country:US
Mailing Address - Phone:336-997-5500
Mailing Address - Fax:
Practice Address - Street 1:1056 W BANK ST
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27101-4914
Practice Address - Country:US
Practice Address - Phone:336-997-5500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-18
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health