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NPI Code Detail

MEDICARE: POSITIVE LIVING GROUP

MEDICARE: POSITIVE LIVING GROUP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251S00000XCommunity/Behavioral Health Agency

General Provider Information

NPI Number : 1336614130
Entity Type Code : Organization
Provider Name (Legal Business Name) : POSITIVE LIVING GROUP
Provider Business Mailing Address
First Line : 40 CREST RIDGE DR
Second Line :
City : JACKSON
State : TN
Zip : 38305-8502
Country : US
Telephone Number : 731-267-2861
Fax Number : 877-334-9483
Provider Business Practice Location Address
First Line : 39 MURRAY GUARD DR
Second Line :
City : JACKSON
State : TN
Zip : 38305-3610
Country : US
Telephone Number : 731-267-2861
Fax Number : 877-334-9483
Authorized Official
Title or Position : MANAGING MEMBER
Name : MR. RAYMOND WATT
Credential :
Telephone Number : 731-267-2861
Provider Enumeration Date : 10/08/2018
Last Update Date : 10/26/2022

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Directions to “POSITIVE LIVING GROUP ” Practice Location

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