Provider Demographics
NPI:1013443712
Name:POSITIVE SUPPORT SERVICE
Entity Type:Organization
Organization Name:POSITIVE SUPPORT SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAID WAIVER PROVIDER
Authorized Official - Prefix:MR
Authorized Official - First Name:EMBRIGE
Authorized Official - Middle Name:
Authorized Official - Last Name:BEMBRY
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:863-845-6323
Mailing Address - Street 1:1046 SUMMER GLEN DR
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880-1933
Mailing Address - Country:US
Mailing Address - Phone:863-845-6323
Mailing Address - Fax:
Practice Address - Street 1:1046 SUMMER GLEN DR
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-1933
Practice Address - Country:US
Practice Address - Phone:863-845-6323
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-02
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities