Provider Demographics
NPI:1881200152
Name:POSITIVE ENERGY HEALTH CENTER LLC
Entity Type:Organization
Organization Name:POSITIVE ENERGY HEALTH CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:CROWE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:317-565-7217
Mailing Address - Street 1:5023 E 56TH ST STE 130
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46226-1471
Mailing Address - Country:US
Mailing Address - Phone:317-565-7217
Mailing Address - Fax:
Practice Address - Street 1:5023 E 56TH ST STE 130
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46226-1471
Practice Address - Country:US
Practice Address - Phone:317-565-7217
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-21
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty