Healthcare Provider Details

I. General information

NPI: 1720722416
Provider Name (Legal Business Name): POSITIVE BEHAVIOR SUPPORTS CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2022
Last Update Date: 04/27/2022
Certification Date: 04/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1802 N IMPERIAL AVE STE D130
EL CENTRO CA
92243-1325
US

IV. Provider business mailing address

7108 S KANNER HWY
STUART FL
34997-7462
US

V. Phone/Fax

Practice location:
  • Phone: 855-832-6727
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name: JAKOB TRUJILLO
Title or Position: BEHAVIORAL ASSISTANT
Credential:
Phone: 760-554-9797