Provider Demographics
NPI:1275046476
Name:POSITIVE LIVING HOME HEALTHCARE LLC
Entity Type:Organization
Organization Name:POSITIVE LIVING HOME HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANTONETTE
Authorized Official - Middle Name:LAVERN
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, QMHP
Authorized Official - Phone:757-235-1161
Mailing Address - Street 1:208 ROCKWOOD PL
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435
Mailing Address - Country:US
Mailing Address - Phone:757-235-1161
Mailing Address - Fax:
Practice Address - Street 1:4410 E CLAIBORNE SQUARE
Practice Address - Street 2:SUITE 334
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666
Practice Address - Country:US
Practice Address - Phone:757-251-3800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-09
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health