Basic Information
| Provider Information | |||||||||
| NPI: | 1598027039 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | POSITIVE BEHAVIOR SUPPORTS CORP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8108 SE COCONUT ST | ||||||||
| Address2: | |||||||||
| City: | HOBE SOUND | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334554008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5613123940 | ||||||||
| FaxNumber: | 7726759100 | ||||||||
| Practice Location | |||||||||
| Address1: | 8108 SE COCONUT ST | ||||||||
| Address2: | |||||||||
| City: | HOBE SOUND | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334554008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8558326727 | ||||||||
| FaxNumber: | 7726759100 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2012 | ||||||||
| LastUpdateDate: | 05/30/2013 | ||||||||
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| AuthorizedOfficialLastName: | NOLAN | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7723496317 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QH0100X | Y | Ambulatory Health Care Facilities | Clinic/Center | Health Service |
No ID Information.