Healthcare Provider Details

I. General information

NPI: 1669128740
Provider Name (Legal Business Name): ACTIVE AT HOME SENIOR SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2022
Last Update Date: 08/30/2023
Certification Date: 08/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3523 COURTLAND DR
DURHAM NC
27707-5134
US

IV. Provider business mailing address

4711 HOPE VALLEY RD STE 4F-417
DURHAM NC
27707-5651
US

V. Phone/Fax

Practice location:
  • Phone: 919-605-6105
  • Fax:
Mailing address:
  • Phone: 919-605-6105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER BREWER
Title or Position: OWNER
Credential: DPT, GCS
Phone: 919-605-6105