MEDICARE: POSITIVE MOVEMENT,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	320800000X	Mental Illness Community Based Residential Treatment Facility	BH5067	AZ

General Provider Information

NPI Number	:	1558797654
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POSITIVE MOVEMENT,LLC

Provider Business Mailing Address
First Line	:	2303 N 44TH ST STE 14-1118
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85008-2446
Country	:	US
Telephone Number	:	313-516-5554
Fax Number	:	480-365-0763

Provider Business Practice Location Address
First Line	:	2303 NORTH 44TH ST #14-1118
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85008-2442
Country	:	US
Telephone Number	:	313-516-5554
Fax Number	:	480-365-0763

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	MR. JONATHAN HOMER HARMON
Credential	:
Telephone Number	:	313-516-5554

Provider Enumeration Date	:	09/20/2013
Last Update Date	:	02/28/2017

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