Healthcare Provider Details

I. General information

NPI: 1659882066
Provider Name (Legal Business Name): ACTIVE HOME CARE SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2017
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9211 CORPORATE BLVD STE 255
ROCKVILLE MD
20850-3856
US

IV. Provider business mailing address

9211 CORPORATE BLVD STE 255
ROCKVILLE MD
20850-3856
US

V. Phone/Fax

Practice location:
  • Phone: 240-238-1110
  • Fax: 240-238-1112
Mailing address:
  • Phone: 240-238-1110
  • Fax: 240-542-4047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code3140N1450X
TaxonomyPediatric Skilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. SHADRACK JORAM BAMPEBUYE
Title or Position: ADMINISTRATOR / OWNER
Credential:
Phone: 301-683-4270