Healthcare Provider Details

I. General information

NPI: 1851990121
Provider Name (Legal Business Name): ACTIVE LIFE HEALTH OF COLUMBIA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2020
Last Update Date: 10/19/2020
Certification Date: 10/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 CENTER POINT RD STE 2360
COLUMBIA SC
29210-5826
US

IV. Provider business mailing address

2000 CENTER POINT RD STE 2360
COLUMBIA SC
29210-5826
US

V. Phone/Fax

Practice location:
  • Phone: 803-233-5500
  • Fax:
Mailing address:
  • Phone: 803-233-5500
  • Fax:

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: JOHN J RUSH
Title or Position: CHAIRMAN & CHIEF EXECUTIVE OFFICER
Credential: MD
Phone: 803-233-5500