Provider Demographics
NPI:1518008945
Name:POSITIVE REINFORCEMENT
Entity Type:Organization
Organization Name:POSITIVE REINFORCEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHEIF EXECTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:SHELTON
Authorized Official - Middle Name:LEON
Authorized Official - Last Name:MELVIN
Authorized Official - Suffix:
Authorized Official - Credentials:AP, BS
Authorized Official - Phone:910-425-7391
Mailing Address - Street 1:3311 LAKE BEND DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28311-7661
Mailing Address - Country:US
Mailing Address - Phone:910-425-7391
Mailing Address - Fax:910-484-1704
Practice Address - Street 1:3311 LAKE BEND DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28311-7661
Practice Address - Country:US
Practice Address - Phone:910-425-7391
Practice Address - Fax:910-484-1704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-009-027322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC=========Medicare ID - Type UnspecifiedRESIDENTIAL TREATMENT