Provider Demographics
NPI:1518656560
Name:POSITIVE DEVELOPMENT OF CALIFORNIA PC
Entity Type:Organization
Organization Name:POSITIVE DEVELOPMENT OF CALIFORNIA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CAMERON
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:KEIRNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-626-3458
Mailing Address - Street 1:8605 SANTA MONICA BLVD
Mailing Address - Street 2:PMB 90451
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90069-4109
Mailing Address - Country:US
Mailing Address - Phone:833-587-1784
Mailing Address - Fax:
Practice Address - Street 1:1525 E 55TH ST STE 302
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60615-5586
Practice Address - Country:US
Practice Address - Phone:833-587-1784
Practice Address - Fax:954-756-9593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-04
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health