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General NPI Number Information
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NPI Number | 1205184157
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Entity Type | Organization
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Legal Business Name | POSITIVE LIVING CHOICES LLC
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Dates
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Enumeration Date | 08/27/2012
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Last Update Date | 08/27/2012
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Provider Practice Location Address
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Address Line | 1735 MONTICELLO ST
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City | PETERSBURG
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State | VA
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Zip | 23805-1640
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Country | US
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Telephone | 704-726-7780
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 303
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City | COLONIAL HEIGHTS
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State | VA
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Zip | 23834-0303
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | MR. CARLOS WILKINS
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Credential |
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Telephone | 804-647-4358
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 320700000X
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Taxonomy Name | Physical Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number |
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License Number State |
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