Provider Demographics
NPI:1518679430
Name:POSITIVELIFESTYLES LLC
Entity Type:Organization
Organization Name:POSITIVELIFESTYLES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:NICHOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:HATCH
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:804-840-2791
Mailing Address - Street 1:1504 PROFESSOR CT
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23228-3331
Mailing Address - Country:US
Mailing Address - Phone:804-840-2791
Mailing Address - Fax:804-264-1794
Practice Address - Street 1:1504 PROFESSOR CT
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23228-3331
Practice Address - Country:US
Practice Address - Phone:804-840-2791
Practice Address - Fax:804-264-1794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-22
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health