Healthcare Provider Details

I. General information

NPI: 1467873745
Provider Name (Legal Business Name): I'M POSITIVE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2014
Last Update Date: 01/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

871 CORONADO CENTER DR SUITE 200
HENDERSON NV
89052-3977
US

IV. Provider business mailing address

871 CORONADO CENTER DR SUITE 200
HENDERSON NV
89052-3977
US

V. Phone/Fax

Practice location:
  • Phone: 888-799-9355
  • Fax: 888-799-9533
Mailing address:
  • Phone: 888-799-9355
  • Fax: 888-799-9533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License NumberNV20111281611
License Number StateNV

VIII. Authorized Official

Name: THOMAS LAHEY
Title or Position: PRESIDENT & EXECUTIVE DIRECTOR
Credential:
Phone: 888-799-9355