Provider Demographics
NPI:1033216734
Name:CMJ POSITIVE CHANGE LLC
Entity Type:Organization
Organization Name:CMJ POSITIVE CHANGE LLC
Other - Org Name:CMJ POSITIVE CHANGE LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ISALENE
Authorized Official - Middle Name:D
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-342-4183
Mailing Address - Street 1:202 LEE ST
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-5319
Mailing Address - Country:US
Mailing Address - Phone:757-923-1200
Mailing Address - Fax:757-638-7662
Practice Address - Street 1:202 LEE ST
Practice Address - Street 2:202 LEE ST
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-5319
Practice Address - Country:US
Practice Address - Phone:757-923-1200
Practice Address - Fax:757-638-7662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities