Provider Demographics
NPI: | 1639635154 |
---|---|
Name: | LOVE FOCUS INTERNATIONAL ASSOCIATION LFIA |
Entity Type: | Organization |
Organization Name: | LOVE FOCUS INTERNATIONAL ASSOCIATION LFIA |
Other - Org Name: | LOVE FOCUS YOUTH OUTREACH |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | CEO/INFORMATION TECHNOLOGY DIRECTOR |
Authorized Official - Prefix: | |
Authorized Official - First Name: | THEOPHILUS |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | NKWOPARA |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 209-869-5800 |
Mailing Address - Street 1: | PO BOX 3704 |
Mailing Address - Street 2: | |
Mailing Address - City: | MERCED |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 95344-3704 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 209-869-5800 |
Mailing Address - Fax: | 866-310-8868 |
Practice Address - Street 1: | 108 W ALEXANDER AVE |
Practice Address - Street 2: | |
Practice Address - City: | MERCED |
Practice Address - State: | CA |
Practice Address - Zip Code: | 95348-3410 |
Practice Address - Country: | US |
Practice Address - Phone: | 209-233-9024 |
Practice Address - Fax: | 866-310-8868 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | LOVE FOCUS INTERNATIONAL ASSOCIATION |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2019-02-20 |
Last Update Date: | 2023-03-02 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 171M00000X | Other Service Providers | Case Manager/Care Coordinator | Group - Multi-Specialty | |
No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
No | 101YP2500X | Behavioral Health & Social Service Providers | Counselor | Professional | Group - Multi-Specialty |
No | 163WC0400X | Nursing Service Providers | Registered Nurse | Case Management | Group - Multi-Specialty |
No | 164X00000X | Nursing Service Providers | Licensed Vocational Nurse | Group - Multi-Specialty | |
No | 251B00000X | Agencies | Case Management | Group - Multi-Specialty | |
No | 251C00000X | Agencies | Day Training, Developmentally Disabled Services | Group - Multi-Specialty | |
No | 251S00000X | Agencies | Community/Behavioral Health | Group - Multi-Specialty | |
No | 251X00000X | Agencies | Supports Brokerage | Group - Multi-Specialty | |
No | 3104A0630X | Nursing & Custodial Care Facilities | Assisted Living Facility | Assisted Living, Behavioral Disturbances | Group - Multi-Specialty |
No | 320900000X | Residential Treatment Facilities | Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | Group - Multi-Specialty | |
No | 374K00000X | Nursing Service Related Providers | Religious Nonmedical Practitioner | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
CA | 285790 | Other | BVN AND PSYCHIATRIC TECHNICIANS |
CA | 247207212 | Other | FACILITY |
CA | 768074 | Other | CALIFORNIA BOARD OF REGISTEREDNURSING - BRN |
CA | 65927 | Other | BBS/LICENSED CLINICAL SOCIAL WORKER |
CA | 851729 | Other | CALIFORNIA BOARD OF REGISTEREDNURSING - BRN |
CA | 289669 | Other | BVN AND PSYCHIATRIC TECHNICIANS |
CA | C3791162 | Other | SECRETARY OF STATE |
CA | C4564277 | Other | SECRETARY OF STATE |
CA | 813953 | Other | CALIFORNIA BOARD OF REGISTEREDNURSING - BRN |
CA | 279040 | Other | B VN AND PSYCHIATRIC TECHNICIANS |