Healthcare Provider Details

I. General information

NPI: 1033659701
Provider Name (Legal Business Name): CENTER FOR POSITIVE CHANGES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2017
Last Update Date: 05/15/2023
Certification Date: 05/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9671 KENORA LN
SPRING VALLEY CA
91977-2902
US

IV. Provider business mailing address

PO BOX 1154
LEMON GROVE CA
91946-1154
US

V. Phone/Fax

Practice location:
  • Phone: 619-741-8006
  • Fax:
Mailing address:
  • Phone: 619-660-3886
  • Fax: 619-660-6604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: DEANNA MELLOS
Title or Position: DIRECTOR
Credential:
Phone: 619-248-0552