Provider Demographics
NPI:1013459643
Name:POSITIVE LIFE STYLES
Entity Type:Organization
Organization Name:POSITIVE LIFE STYLES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IRIS
Authorized Official - Middle Name:H
Authorized Official - Last Name:REID
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-281-3967
Mailing Address - Street 1:4805 GREEN WING RD
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893-8142
Mailing Address - Country:US
Mailing Address - Phone:252-281-3967
Mailing Address - Fax:252-674-7060
Practice Address - Street 1:4805 GREEN WING RD
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-8142
Practice Address - Country:US
Practice Address - Phone:252-281-3967
Practice Address - Fax:252-674-7060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-14
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL098033311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCFCL098033OtherPROVIDER LICENSE