Healthcare Provider Details

I. General information

NPI: 1982937819
Provider Name (Legal Business Name): ACTIVE HEALTH CARE SUPPLIES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2009
Last Update Date: 09/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1080 S VAN DYKE RD
BAD AXE MI
48413-9635
US

IV. Provider business mailing address

1080 S VAN DYKE RD
BAD AXE MI
48413-9635
US

V. Phone/Fax

Practice location:
  • Phone: 989-269-5400
  • Fax: 989-269-5420
Mailing address:
  • Phone: 989-269-5400
  • Fax: 989-269-5420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: ELIAS KABBAN
Title or Position: OWNER
Credential:
Phone: 989-269-5400