Healthcare Provider Details

I. General information

NPI: 1659891760
Provider Name (Legal Business Name): ACTIVATE HEALTHCARE-OHIO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2017
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 RODEO DR
ERLANGER KY
41018-1279
US

IV. Provider business mailing address

2157 N DAMEN AVE
CHICAGO IL
60647-6916
US

V. Phone/Fax

Practice location:
  • Phone: 859-342-0901
  • Fax: 859-342-0919
Mailing address:
  • Phone: 773-967-3144
  • Fax: 872-808-2119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: DEBRA GEIHSLER
Title or Position: PRINCIPAL
Credential:
Phone: 773-704-7002