MEDICARE: ACTIVE LIFE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1467829812
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACTIVE LIFE

Provider Business Mailing Address
First Line	:	2939 N 5TH ST
Second Line	:	B
City	:	PHILADELPHIA
State	:	PA
Zip	:	19133-2802
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2939 N 5TH ST
Second Line	:	B
City	:	PHILADELPHIA
State	:	PA
Zip	:	19133-2802
Country	:	US
Telephone Number	:	215-423-3601
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ARUT BALUYAN
Credential	:
Telephone Number	:	215-423-3601

Provider Enumeration Date	:	09/01/2015
Last Update Date	:	09/01/2015

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Directions to “ACTIVE LIFE ” Practice Location

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