Healthcare Provider Details

I. General information

NPI: 1215755046
Provider Name (Legal Business Name): POSITIVE MOMENTS HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2024
Last Update Date: 10/01/2024
Certification Date: 10/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

762 BENT CREEK DR
FORT PIERCE FL
34947-1322
US

IV. Provider business mailing address

762 BENT CREEK DR
FORT PIERCE FL
34947-1322
US

V. Phone/Fax

Practice location:
  • Phone: 772-672-1241
  • Fax:
Mailing address:
  • Phone: 772-672-1241
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: TONETTA LEE
Title or Position: CEO/OWNER
Credential: LPN, LNHA
Phone: 772-672-1241