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General NPI Number Information
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NPI Number | 1326186578
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Entity Type | Organization
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Legal Business Name | A POSITIVE LIFE
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Dates
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Enumeration Date | 02/01/2007
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Last Update Date | 09/10/2007
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Provider Practice Location Address
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Address Line | 6033 CONCHO CT
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City | FAYETTEVILLE
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State | NC
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Zip | 28303-2509
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Country | US
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Telephone | 910-480-2555
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Fax | 910-323-3206
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Provider Business Mailing Address
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Address Line | 351 WAGONER DR
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City | FAYETTEVILLE
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State | NC
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Zip | 28303-4608
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Country | US
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Telephone | 910-223-7300
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Fax | 910-323-3206
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. WALTER YOUNG
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Credential | BS
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Telephone | 910-223-7300
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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 | MHL026742
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License Number State | NC
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