Healthcare Provider Details

I. General information

NPI: 1922837830
Provider Name (Legal Business Name): ACTIVE ANCHOR HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2024
Last Update Date: 07/29/2024
Certification Date: 07/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 WILMINGTON DR
WARNER ROBINS GA
31088-9024
US

IV. Provider business mailing address

PO BOX 10461
WARNER ROBINS GA
31095-5461
US

V. Phone/Fax

Practice location:
  • Phone: 478-832-2421
  • Fax:
Mailing address:
  • Phone: 478-832-2421
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: KWATORIA L BRYANT
Title or Position: CEO
Credential:
Phone: 478-832-2421