FOCUSED ADDICTION RECOVERY LLC — NPI 1053052134 (Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center in WALLACE, NC)

CMS-1500 Box 24J / 33a • NPI

1053052134

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

261QR0405X (CMS D5)

Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center

Box 32 Service Location & ZIP+4

102 W MAIN ST, WALLACE, NC, 28466-2902

✓ 9-Digit EDI 837 ZIP+4 (28466-2902)

Practice Phone & Referral Fax

(630) 334-2019

Direct NPPES Verification Line

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1053052134 (FOCUSED ADDICTION RECOVERY LLC) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

Institutional Type-2 NPI facilities enroll via CMS-855A institutional provider agreements rather than individual Order & Referring PECOS.

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1053052134` (NPI-2 Organization / Facility)
Provider / Legal Name	FOCUSED ADDICTION RECOVERY LLC
Plain-English Specialty	Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center NUCC Code: `261QR0405X` (Clinic/Center, Rehabilitation, Substance Use Disorder)
Certifying / Licensing Body	Accreditation Association for Ambulatory Health Care (AAAHC) / CMS
Practice Location Address	102 W MAIN ST, WALLACE, NC, 28466-2902
Practice Telephone / Fax	Tel: (630) 334-2019
Administrative Mailing Address	102 W MAIN ST, WALLACE, NC, 28466-2902
Enumeration & Last Sync	Enumerated: 2022-04-05 \| CMS Record Updated: 2024-08-30
Authorized Official	THOMAS FERENCE (CEO)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

102 W MAIN ST, WALLACE, NC, 28466-2902

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Plain-English Taxonomy & CMS Crosswalk (261QR0405X)

What Does Taxonomy Code 261QR0405X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 261QR0405X translates to:
"Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center"

CMS-1500 Medicare Specialty Crosswalk: CMS Code D5 (Opioid Treatment Program)
Certifying / Accrediting Authority: Accreditation Association for Ambulatory Health Care (AAAHC) / CMS
Clinical Scope: Same-day outpatient consultations, urgent walk-in medical care, vaccinations, and day-case diagnostic procedures.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (FOCUSED ADDICTION RECOVERY LLC)

Typical CPT / Diagnostic Procedures:

Walk-In Urgent Care Evaluation, Point-of-Care Testing & X-Ray
Same-Day Ambulatory Endoscopy, Cataract & Minor Surgical Procedures

Common Therapeutic Classes:

Outpatient Oral Antimicrobials, Analgesics, Nebulizers & Vaccines

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`101YA0400X` — Counselor, Addiction (Substance Use Disorder) Plain English: Licensed & Credentialed Counselor, Addiction (Substance Use Disorder)	State: N/A \| License: `Verified` \| Primary: Secondary
`101YM0800X` — Counselor, Mental Health Plain English: Licensed & Credentialed Behavioral Health & Social Service Providers — Counselor	State: N/A \| License: `Verified` \| Primary: Secondary
`207QA0401X` — Family Medicine, Addiction Medicine Plain English: Board-Certified Family Medicine Physician (All-Ages Primary Care Doctor)	State: N/A \| License: `Verified` \| Primary: Secondary
`207RA0401X` — Internal Medicine, Addiction Medicine Plain English: Board-Certified Internist (Adult Diagnostic & Chronic Disease Physician)	State: N/A \| License: `Verified` \| Primary: Secondary
`2083A0300X` — Preventive Medicine, Addiction Medicine Plain English: Licensed & Credentialed Allopathic & Osteopathic Physicians — Preventive Medicine — Addiction Medicine	State: N/A \| License: `Verified` \| Primary: Secondary
`2084A0401X` — Psychiatry & Neurology, Addiction Medicine Plain English: Board-Certified Neurologist (Brain, Spine, Stroke & Nerve Specialist)	State: N/A \| License: `Verified` \| Primary: Secondary
`251S00000X` — Community/Behavioral Health Plain English: Licensed & Credentialed Community/Behavioral Health	State: N/A \| License: `Verified` \| Primary: Secondary
`261QM0801X` — Clinic/Center, Mental Health (Including Community Mental Health Center) Plain English: Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center	State: N/A \| License: `Verified` \| Primary: Secondary
`261QM0850X` — Clinic/Center, Adult Mental Health Plain English: Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center	State: N/A \| License: `Verified` \| Primary: Secondary
`261QR0405X` — Clinic/Center, Rehabilitation, Substance Use Disorder Plain English: Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center	State: N/A \| License: `Verified` \| Primary: Yes (Primary)
`324500000X` — Substance Abuse Rehabilitation Facility Plain English: Licensed & Credentialed Substance Abuse Rehabilitation Facility	State: N/A \| License: `Verified` \| Primary: Secondary
`343900000X` — Non-emergency Medical Transport (VAN) Plain English: Licensed & Credentialed Non-emergency Medical Transport (VAN)	State: N/A \| License: `Verified` \| Primary: Secondary

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FOCUSED ADDICTION RECOVERY LLC (NPI #1053052134)