MEDICARE: POSITIVE KINSHIP BONDING, INC.

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	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1831832872
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POSITIVE KINSHIP BONDING, INC.

Provider Business Mailing Address
First Line	:	820 CHESAPEAKE ST SE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20032-3428
Country	:	US
Telephone Number	:	202-248-1083
Fax Number	:

Provider Business Practice Location Address
First Line	:	820 CHESAPEAKE ST SE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20032-3428
Country	:	US
Telephone Number	:	202-550-0545
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MRS. BEVERLY RUSSAU WEAVER
Credential	:	DSW, LISW
Telephone Number	:	202-550-0545

Provider Enumeration Date	:	04/18/2022
Last Update Date	:	04/18/2022

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