Provider Demographics
NPI:1861235616
Name:POSITIVE KIDS LLC
Entity type:Organization
Organization Name:POSITIVE KIDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:
Authorized Official - Last Name:WIAFE
Authorized Official - Suffix:
Authorized Official - Credentials:RP
Authorized Official - Phone:647-629-1151
Mailing Address - Street 1:36216 FREEDOM RD UNIT 93
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48335-3002
Mailing Address - Country:US
Mailing Address - Phone:866-503-7454
Mailing Address - Fax:
Practice Address - Street 1:36216 FREEDOM RD UNIT 93
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48335-3002
Practice Address - Country:US
Practice Address - Phone:866-503-7454
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health