Healthcare Provider Details

I. General information

NPI: 1346960812
Provider Name (Legal Business Name): ACTIVE SENIOR CARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2022
Last Update Date: 12/02/2022
Certification Date: 12/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8450 LOCKWOOD RIDGE RD
SARASOTA FL
34243-2920
US

IV. Provider business mailing address

3902 E STATE ROAD 64
BRADENTON FL
34208-9059
US

V. Phone/Fax

Practice location:
  • Phone: 941-277-5048
  • Fax:
Mailing address:
  • Phone: 941-277-5048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ERIC KINGSLEY
Title or Position: DIRECTOR
Credential:
Phone: 941-277-5048