Healthcare Provider Details

I. General information

NPI: 1144777079
Provider Name (Legal Business Name): ACTIVE MA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2016
Last Update Date: 09/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

265 BENTON DR SUITE 201
EAST LONGMEADOW MA
01028-3219
US

IV. Provider business mailing address

6 NESHAMINY INTERPLEX SUITE 401
TREVOSE PA
19053-6964
US

V. Phone/Fax

Practice location:
  • Phone: 413-525-2124
  • Fax: 413-525-5691
Mailing address:
  • Phone: 215-642-6600
  • Fax: 215-642-6610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: CRAIG O MEHNERT
Title or Position: COO
Credential:
Phone: 215-642-6600