MEDICARE: POSITIVE CHANGE OUTSOURCES LLC

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
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1477140598
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POSITIVE CHANGE OUTSOURCES LLC

Provider Business Mailing Address
First Line	:	5520 OATFIELD ST
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89081-2979
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5520 OATFIELD ST
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89081-2979
Country	:	US
Telephone Number	:	725-219-3207
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	FRANCES JOHNSON
Credential	:
Telephone Number	:	725-219-3207

Provider Enumeration Date	:	12/22/2020
Last Update Date	:	12/22/2020

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Directions to “POSITIVE CHANGE OUTSOURCES LLC ” Practice Location

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