Provider Demographics
NPI:1831212430
Name:POSITIVE DIRECTIONS WELLNESS CENTER
Entity type:Organization
Organization Name:POSITIVE DIRECTIONS WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASSAGE THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:EVORA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BORR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-994-6801
Mailing Address - Street 1:327 N RIVER AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-2180
Mailing Address - Country:US
Mailing Address - Phone:616-994-6801
Mailing Address - Fax:
Practice Address - Street 1:327 N RIVER AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424-2180
Practice Address - Country:US
Practice Address - Phone:616-994-6801
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MICERTIFIED225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty