MEDICARE: POSITIVE LIFE BEHAVIORAL HEALTH SERVICES

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	:	1780144881
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POSITIVE LIFE BEHAVIORAL HEALTH SERVICES

Provider Business Mailing Address
First Line	:	3740 WEST HUNDRED ROAD
Second Line	:
City	:	CHESTER
State	:	VA
Zip	:	23831
Country	:	US
Telephone Number	:	804-748-6402
Fax Number	:	804-748-6357

Provider Business Practice Location Address
First Line	:	3740 WEST HUNDRED ROAD
Second Line	:
City	:	CHESTER
State	:	VA
Zip	:	23831
Country	:	US
Telephone Number	:	804-748-6402
Fax Number	:	804-748-6357

Authorized Official
Title or Position	:	CEO/PROGRAM DIRECTOR
Name	:	EUGENE ALSTON
Credential	:	MA BS QMHP-A/QMHP-C
Telephone Number	:	804-247-8262

Provider Enumeration Date	:	03/23/2019
Last Update Date	:	03/23/2019

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