Healthcare Provider Details

I. General information

NPI: 1447559687
Provider Name (Legal Business Name): ACTIVE LIFE AND HEALTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2011
Last Update Date: 07/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 JACKSON STREET EXT
ALEXANDRIA LA
71303-3040
US

IV. Provider business mailing address

PO BOX 586
YUBA CITY CA
95992-0586
US

V. Phone/Fax

Practice location:
  • Phone: 888-525-0255
  • Fax: 888-525-0255
Mailing address:
  • Phone: 888-525-0255
  • Fax: 888-525-0255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. JEFFREY A SOUZA
Title or Position: PRESIDENT
Credential:
Phone: 888-525-0255