Healthcare Provider Details

I. General information

NPI: 1285087239
Provider Name (Legal Business Name): ACTIVE CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2016
Last Update Date: 07/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1019 VALLEY VIEW RD
FORT COLLINS CO
80524-1540
US

IV. Provider business mailing address

1019 VALLEY VIEW RD
FORT COLLINS CO
80524-1540
US

V. Phone/Fax

Practice location:
  • Phone: 970-420-2061
  • Fax:
Mailing address:
  • Phone: 970-420-2061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: NATHANIEL ARTHUR RINGDAHL
Title or Position: CEO
Credential:
Phone: 970-420-2061