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General NPI Number Information
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NPI Number | 1275046476
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Entity Type | Organization
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Legal Business Name | POSITIVE LIVING HOME HEALTHCARE LLC
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Dates
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Enumeration Date | 11/09/2017
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Last Update Date | 11/09/2017
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Provider Practice Location Address
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Address Line | 4410 E CLAIBORNE SQUARE SUITE 334
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City | HAMPTON
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State | VA
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Zip | 23666
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Country | US
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Telephone | 757-251-3800
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Fax |
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Provider Business Mailing Address
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Address Line | 208 ROCKWOOD PL
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City | SUFFOLK
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State | VA
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Zip | 23435
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Country | US
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Telephone | 757-235-1161
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | ANTONETTE LAVERN HARRIS
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Credential | MS, QMHP
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Telephone | 757-235-1161
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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