Provider Demographics
NPI:1891841607
Name:POSITIVE LIFESTYLES, LLC
Entity Type:Organization
Organization Name:POSITIVE LIFESTYLES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVE
Authorized Official - Middle Name:
Authorized Official - Last Name:WHEELOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-725-7960
Mailing Address - Street 1:PO BOX 849
Mailing Address - Street 2:302 BALBOA DRIVE
Mailing Address - City:DELANO
Mailing Address - State:CA
Mailing Address - Zip Code:93216-0849
Mailing Address - Country:US
Mailing Address - Phone:661-725-7960
Mailing Address - Fax:661-725-6876
Practice Address - Street 1:302 BALBOA DR
Practice Address - Street 2:
Practice Address - City:DELANO
Practice Address - State:CA
Practice Address - Zip Code:93215-4007
Practice Address - Country:US
Practice Address - Phone:661-725-7960
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12-0000428310500000X
CA12-0000429310500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310500000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALTC80114GOtherLONG-TERM CARE FACILITY
CALTC80113GOtherLONG-TERM CARE FACILITY