Healthcare Provider Details

I. General information

NPI: 1114449642
Provider Name (Legal Business Name): ACTIVE ADULT CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2017
Last Update Date: 07/21/2022
Certification Date: 03/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 BRYAN RD
BRANDON FL
33511-6145
US

IV. Provider business mailing address

909 BRYAN RD
BRANDON FL
33511-6145
US

V. Phone/Fax

Practice location:
  • Phone: 813-571-1227
  • Fax: 813-571-1228
Mailing address:
  • Phone: 813-571-1227
  • Fax: 813-571-1228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number9388
License Number StateFL

VIII. Authorized Official

Name: MRS. CLAUDIA ALUR
Title or Position: MANAGER
Credential: PT, DPT
Phone: 813-571-1227