Provider Demographics
NPI:1346711330
Name:POSITIVE ACHIEVEMENTS, LLC
Entity Type:Organization
Organization Name:POSITIVE ACHIEVEMENTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:M
Authorized Official - Last Name:MCCREERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-389-7874
Mailing Address - Street 1:12713 HIGHWAY M
Mailing Address - Street 2:
Mailing Address - City:STARK CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64866-8053
Mailing Address - Country:US
Mailing Address - Phone:417-389-7874
Mailing Address - Fax:417-472-6948
Practice Address - Street 1:12713 HIGHWAY M
Practice Address - Street 2:
Practice Address - City:STARK CITY
Practice Address - State:MO
Practice Address - Zip Code:64866-8053
Practice Address - Country:US
Practice Address - Phone:417-389-7874
Practice Address - Fax:417-472-6948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO123456Medicaid