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General NPI Number Information
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NPI Number | 1154589661
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Entity Type | Organization
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Legal Business Name | POSITIVE LIFESTYLES LLC
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Dates
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Enumeration Date | 05/30/2008
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Last Update Date | 05/30/2008
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Provider Practice Location Address
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Address Line | 422 BALBOA DR
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City | DELANO
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State | CA
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Zip | 93215-4006
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Country | US
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Telephone | 661-725-7960
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 849
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City | DELANO
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State | CA
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Zip | 93216-0849
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Country | US
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Telephone | 661-715-7960
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DAVE WHEELOCK
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Credential |
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Telephone | 661-725-7960
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number | 120000428
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License Number State | CA
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