Provider Demographics
NPI:1245850403
Name:POSITIVE PATH LLC
Entity type:Organization
Organization Name:POSITIVE PATH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REBA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRADY
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:907-841-5434
Mailing Address - Street 1:7647 W TIA TERRACE DR
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99623-0332
Mailing Address - Country:US
Mailing Address - Phone:907-841-5434
Mailing Address - Fax:
Practice Address - Street 1:7647 W TIA TERRACE DR
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99623-0332
Practice Address - Country:US
Practice Address - Phone:907-841-5434
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-17
Last Update Date:2020-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1624131Medicaid