Provider Demographics
NPI:1215755046
Name:POSITIVE MOMENTS HEALTH SERVICES LLC
Entity type:Organization
Organization Name:POSITIVE MOMENTS HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TONETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:LPN, LNHA
Authorized Official - Phone:772-672-1241
Mailing Address - Street 1:762 BENT CREEK DR
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34947-1322
Mailing Address - Country:US
Mailing Address - Phone:772-672-1241
Mailing Address - Fax:
Practice Address - Street 1:762 BENT CREEK DR
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34947-1322
Practice Address - Country:US
Practice Address - Phone:772-672-1241
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-01
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL113301100Medicaid