Provider Demographics
NPI:1841846615
Name:POSITIVE GENERATION IN CHRIST, INCORPORATED
Entity type:Organization
Organization Name:POSITIVE GENERATION IN CHRIST, INCORPORATED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:IMMACULA
Authorized Official - Middle Name:
Authorized Official - Last Name:SAINT LOUIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:667-401-5936
Mailing Address - Street 1:PO BOX 1634
Mailing Address - Street 2:
Mailing Address - City:TARBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27886-1634
Mailing Address - Country:US
Mailing Address - Phone:252-641-4522
Mailing Address - Fax:
Practice Address - Street 1:109 BEACON RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21220-3504
Practice Address - Country:US
Practice Address - Phone:252-813-2530
Practice Address - Fax:252-641-5461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-16
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)Group - Single Specialty
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC251SOOOOOXMedicaid