Organization Active NPI

Positive Behavior Support Corp.

  • Community/Behavioral Health Agency
  • San Diego, CA
National Provider Identifier
1508307125
Registry record updated Mar 15, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
106S00000X Issued in CA
Legal business name
POSITIVE BEHAVIOR SUPPORT CORP.
Practice address
563 Balboa Avenue
#521
San Diego, CA 92111
Phone
(253) 732-1121
NPI assigned
Mar 15, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 15, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kasandra Renee Flores, RBT
Title
Registered Behavior Technician
Phone
(253) 732-1121

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X 106S00000X CA Primary

Addresses

Primary practice location

563 Balboa Avenue
#521
San Diego, CA 92111

Mailing address

563 Balboa Avenue
521
San Diego, CA 92111

Other identifiers 1

IdentifierTypeStateIssuer
106S00000XMedicaidCA

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1489536000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1489536000000",
    "number": "1508307125",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "563 BALBOA AVENUE",
            "address_2": "521",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "92111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "563 BALBOA AVENUE",
            "address_2": "#521",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "92111",
            "telephone_number": "253-732-1121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POSITIVE BEHAVIOR SUPPORT CORP.",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-03-15",
        "last_updated": "2017-03-15",
        "status": "A",
        "authorized_official_last_name": "FLORES",
        "authorized_official_first_name": "KASANDRA",
        "authorized_official_middle_name": "RENEE",
        "authorized_official_title_or_position": "REGISTERED BEHAVIOR TECHNICIAN",
        "authorized_official_telephone_number": "253-732-1121",
        "authorized_official_credential": "RBT"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "CA",
            "license": "106S00000X",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "106S00000X",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.