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General NPI Number Information
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NPI Number | 1891841607
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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 | 01/25/2007
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Last Update Date | 05/07/2008
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Provider Practice Location Address
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Address Line | 302 BALBOA DR
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City | DELANO
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State | CA
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Zip | 93215-4007
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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 849 302 BALBOA DRIVE
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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 | 661-725-7960
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Fax | 661-725-6876
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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 | 310500000X
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Taxonomy Name | Mental Illness Intermediate Care Facility
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License Number | 12-0000428
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 310500000X
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Taxonomy Name | Mental Illness Intermediate Care Facility
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License Number | 12-0000429
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License Number State | CA
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