MEDICARE: POSITIVE HEALTH

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	103K00000X	Behavior Analyst
2	171M00000X	Case Manager/Care Coordinator
3	171W00000X	Contractor
4	172V00000X	Community Health Worker
5	175T00000X	Peer Specialist
6	225400000X	Rehabilitation Practitioner
7	251B00000X	Case Management Agency
8	3747A0650X	Attendant Care Provider
9	3747P1801X	Personal Care Attendant
10	374U00000X	Home Health Aide
11	405300000X	Prevention Professional
12	251K00000X	Public Health or Welfare Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356963193
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POSITIVE HEALTH

Provider Business Mailing Address
First Line	:	6550 S PECOS RD STE B-115
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-2828
Country	:	US
Telephone Number	:	415-690-6635
Fax Number	:

Provider Business Practice Location Address
First Line	:	6550 S PECOS RD STE B-115
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-2828
Country	:	US
Telephone Number	:	415-690-6635
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. PENNY NUNEZ-MCDONOUGH
Credential	:
Telephone Number	:	415-690-6635

Provider Enumeration Date	:	05/14/2020
Last Update Date	:	06/09/2020

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1780008938 — MS. PENNY NUNEZ MCDONOUGH
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Directions to “POSITIVE HEALTH ” Practice Location

Language	Start Address	Practice Location

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