Provider Demographics
NPI:1982334595
Name:POSITIVE BEHAVIOR SUPPORTS CORPORATION
Entity Type:Organization
Organization Name:POSITIVE BEHAVIOR SUPPORTS CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BEHAVIOR TECHNICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ISABELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:COLON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-948-3194
Mailing Address - Street 1:2083 VELVET LEAF DR
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-4883
Mailing Address - Country:US
Mailing Address - Phone:321-948-3194
Mailing Address - Fax:
Practice Address - Street 1:907 OUTER RD STE B
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32814-6601
Practice Address - Country:US
Practice Address - Phone:407-217-1401
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-15
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL105728200Medicaid