Healthcare Provider Details

I. General information

NPI: 1568093987
Provider Name (Legal Business Name): ACTIVE CARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2020
Last Update Date: 08/03/2025
Certification Date: 08/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 BELLANCA RD
BRICK NJ
08723-6877
US

IV. Provider business mailing address

300 BELLANCA RD
BRICK NJ
08723-6877
US

V. Phone/Fax

Practice location:
  • Phone: 718-356-7863
  • Fax:
Mailing address:
  • Phone: 718-354-7863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: RONALD MULINDWA
Title or Position: PRESIDENT
Credential:
Phone: 718-354-7863