1700024296 NPI number — POSITIVE BEHAVIOR SUPPORTS CORPORATION

Table of content: (NPI 1700024296)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700024296 NPI number — POSITIVE BEHAVIOR SUPPORTS CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
POSITIVE BEHAVIOR SUPPORTS CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700024296
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/30/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7108 S KANNER HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STUART
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34997-7462
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
855-832-6727
Provider Business Mailing Address Fax Number:
772-675-9100

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7108 S KANNER HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STUART
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34997-7462
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
855-832-6727
Provider Business Practice Location Address Fax Number:
772-675-9100
Provider Enumeration Date:
01/22/2009

Additional Information

Authorized Official

Authorized Official Last Name:
NOLAN
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
855-832-6727

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  1052377 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0046102 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 003207265A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: GP9390 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 313047 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: Q055266 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 017422400 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 064038079 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 987019900 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3001495591 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: M000058 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 017422400 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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