Provider Demographics
NPI:1265887954
Name:A POSITIVE CHANGE
Entity type:Organization
Organization Name:A POSITIVE CHANGE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-742-1272
Mailing Address - Street 1:582 FARRINGDOM ST
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-2615
Mailing Address - Country:US
Mailing Address - Phone:910-671-4142
Mailing Address - Fax:910-401-1513
Practice Address - Street 1:582 FARRINGDOM ST
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-2615
Practice Address - Country:US
Practice Address - Phone:910-671-4142
Practice Address - Fax:910-401-1513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-29
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone