Healthcare Provider Details

I. General information

NPI: 1710368030
Provider Name (Legal Business Name): POSITIVE OUTLOOK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2015
Last Update Date: 06/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4213 MYLAN RD
RICHMOND VA
23223-2275
US

IV. Provider business mailing address

4213 MYLAN RD
RICHMOND VA
23223-2275
US

V. Phone/Fax

Practice location:
  • Phone: 804-398-1974
  • Fax:
Mailing address:
  • Phone: 804-398-1974
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number370
License Number StateVA

VIII. Authorized Official

Name: JIMMY LAMONT GIGGETTS
Title or Position: OWNER
Credential:
Phone: 804-398-1974