Provider Demographics
NPI:1942988928
Name:POSITIVE BEHAVIOR SUPPORTS CORPORATION
Entity Type:Organization
Organization Name:POSITIVE BEHAVIOR SUPPORTS CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BEHAVIOR ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:JAQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTACRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-672-1636
Mailing Address - Street 1:7108 S KANNER HWY
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-7462
Mailing Address - Country:US
Mailing Address - Phone:772-349-6317
Mailing Address - Fax:
Practice Address - Street 1:2100 STANDIFORD AVE STE 12-180
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-6522
Practice Address - Country:US
Practice Address - Phone:855-832-6727
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Single Specialty