Provider Demographics
NPI:1447724141
Name:CENTER FOR POSITIVE CHANGES STAY
Entity type:Organization
Organization Name:CENTER FOR POSITIVE CHANGES STAY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MELLOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-660-3886
Mailing Address - Street 1:9628 CAMPO RD STE M
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91977-1233
Mailing Address - Country:US
Mailing Address - Phone:619-660-3886
Mailing Address - Fax:
Practice Address - Street 1:5104 ELIOT ST
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92057-2646
Practice Address - Country:US
Practice Address - Phone:760-637-2340
Practice Address - Fax:619-660-6604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-15
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children