Provider Demographics
NPI:1003064171
Name:POSITIVEABA
Entity type:Organization
Organization Name:POSITIVEABA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:
Authorized Official - Last Name:BABINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-361-1025
Mailing Address - Street 1:18521 E QUEEN CREEK RD
Mailing Address - Street 2:SUITE 105-627
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-5866
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:18521 E QUEEN CREEK RD
Practice Address - Street 2:SUTE 105-627
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142-5866
Practice Address - Country:US
Practice Address - Phone:480-361-1025
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-03
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ=========85242A002OtherTRICARE