Provider Demographics
NPI:1962832378
Name:POSITIVE ENERGY LLC
Entity Type:Organization
Organization Name:POSITIVE ENERGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:ROBERTSON
Authorized Official - Last Name:ZORNIK
Authorized Official - Suffix:
Authorized Official - Credentials:CNA
Authorized Official - Phone:208-866-2116
Mailing Address - Street 1:4003 W GLENDALE ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83703-5117
Mailing Address - Country:US
Mailing Address - Phone:208-866-2116
Mailing Address - Fax:208-381-0350
Practice Address - Street 1:4003 W GLENDALE ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83703-5117
Practice Address - Country:US
Practice Address - Phone:208-866-2116
Practice Address - Fax:208-381-0350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-21
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID000000015080253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care