Provider Demographics
NPI:1730942236
Name:POSITIVE RESIDENTIAL CARE, LLC
Entity type:Organization
Organization Name:POSITIVE RESIDENTIAL CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATION DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JONAS
Authorized Official - Middle Name:S
Authorized Official - Last Name:MANYWA
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:207-518-0370
Mailing Address - Street 1:586 WESTBROOK ST UNIT 310
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-1403
Mailing Address - Country:US
Mailing Address - Phone:207-518-0370
Mailing Address - Fax:
Practice Address - Street 1:586 WESTBROOK ST UNIT 310
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-1403
Practice Address - Country:US
Practice Address - Phone:207-518-0370
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-06
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities