Provider Demographics
NPI:1730561358
Name:POSITIVE PATH OF DEERFIELD BEACH
Entity type:Organization
Organization Name:POSITIVE PATH OF DEERFIELD BEACH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NEEDELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-715-3260
Mailing Address - Street 1:1400 EAST HILLSBORO BLVD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33441
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1400 EAST HILLSBORO BLVD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33441
Practice Address - Country:US
Practice Address - Phone:561-715-3260
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-19
Last Update Date:2015-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder