Healthcare Provider Details

I. General information

NPI: 1336696731
Provider Name (Legal Business Name): ACTIVE SC ONE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2016
Last Update Date: 06/30/2020
Certification Date: 06/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 GILES DR
BOILING SPRINGS SC
29316-6036
US

IV. Provider business mailing address

6 NESHAMINY INTERPLEX SUITE 401
TREVOSE PA
19053-6964
US

V. Phone/Fax

Practice location:
  • Phone: 864-599-7342
  • Fax:
Mailing address:
  • Phone: 215-642-6600
  • Fax: 215-642-6610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DEBORA HOCKENBURY
Title or Position: CONTRACTS MANAGER
Credential:
Phone: 215-642-6600