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General NPI Number Information
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NPI Number | 1205230067
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Entity Type | Organization
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Legal Business Name | POSITIVE LIVING INC
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Dates
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Enumeration Date | 10/22/2014
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Last Update Date | 10/22/2014
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Provider Practice Location Address
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Address Line | 3811 W NORTHSIDE DR
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City | JACKSON
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State | MS
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Zip | 39209-2560
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Country | US
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Telephone | 601-209-7990
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Fax | 877-450-0771
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Provider Business Mailing Address
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Address Line | PO BOX 11503
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City | JACKSON
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State | MS
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Zip | 39283-1503
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Country | US
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Telephone | 601-209-7990
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Fax | 877-450-0771
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | PATRICIA MAGEE
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Credential |
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Telephone | 601-209-7990
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 1089
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License Number State | MS
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