Provider Demographics
NPI:1245554625
Name:DISTINCT FOCUS ON LIFE LP
Entity type:Organization
Organization Name:DISTINCT FOCUS ON LIFE LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:LOPER
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:936-422-4440
Mailing Address - Street 1:PO BOX 155953
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75915-5953
Mailing Address - Country:US
Mailing Address - Phone:936-635-2114
Mailing Address - Fax:936-422-4667
Practice Address - Street 1:112 N US HIGHWAY 69
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:TX
Practice Address - Zip Code:75949
Practice Address - Country:US
Practice Address - Phone:936-635-2114
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-15
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities