Healthcare Provider Details

I. General information

NPI: 1235459389
Provider Name (Legal Business Name): POSITIVE CONNECTION CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2010
Last Update Date: 09/15/2023
Certification Date: 09/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1413 GRACEWOOD DR
GREENSBORO NC
27408-5304
US

IV. Provider business mailing address

P.O. BOX 16851
GREENSBORO NC
27416
US

V. Phone/Fax

Practice location:
  • Phone: 336-587-8876
  • Fax: 336-617-5948
Mailing address:
  • Phone: 336-587-8876
  • Fax: 336-617-5948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License NumberMHL-041-959
License Number StateNC

VIII. Authorized Official

Name: MS. ERIKA HELENE HENDRIX
Title or Position: DIRECTOR
Credential:
Phone: 336-587-8876