Provider Demographics
NPI:1033659842
Name:CENTER FOR POSITIVE CHANGES
Entity Type:Organization
Organization Name:CENTER FOR POSITIVE CHANGES
Other - Org Name:CENTER FOR POSITIVE CHANGES 2
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MELLOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-248-0552
Mailing Address - Street 1:PO BOX 1154
Mailing Address - Street 2:
Mailing Address - City:LEMON GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:91946-1154
Mailing Address - Country:US
Mailing Address - Phone:619-660-3886
Mailing Address - Fax:619-660-6604
Practice Address - Street 1:5972 KENYATTA CT
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92114-5512
Practice Address - Country:US
Practice Address - Phone:619-677-2879
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-27
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children