Healthcare Provider Details

I. General information

NPI: 1093682213
Provider Name (Legal Business Name): ACTIVE MA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2025
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 GLENN ST
LAWRENCE MA
01843-1022
US

IV. Provider business mailing address

6 INTERPLEX DR STE 401
TREVOSE PA
19053-6942
US

V. Phone/Fax

Practice location:
  • Phone: 978-213-8744
  • Fax: 978-655-5767
Mailing address:
  • Phone: 215-642-6600
  • Fax: 215-827-5950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE VANSCHAICK
Title or Position: REGULATORY & CONTRACTS ANALYST
Credential:
Phone: 215-642-6600