Healthcare Provider Details

I. General information

NPI: 1114291929
Provider Name (Legal Business Name): POSITIVE LIVING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2012
Last Update Date: 02/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3811 W NORTHSIDE DR
JACKSON MS
39209-2560
US

IV. Provider business mailing address

PO BOX 11503
JACKSON MS
39283-1503
US

V. Phone/Fax

Practice location:
  • Phone: 601-209-7990
  • Fax: 601-366-5949
Mailing address:
  • Phone: 601-209-7990
  • Fax: 601-366-5949

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: PATRICIA B MAGEE
Title or Position: DIRECTOR
Credential:
Phone: 601-209-7990