Healthcare Provider Details

I. General information

NPI: 1649310020
Provider Name (Legal Business Name): ACTIVE SC TWO, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 06/30/2020
Certification Date: 06/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

736 S LINE STREET EXT
GREER SC
29651-4027
US

IV. Provider business mailing address

6 NESHAMINY INTERPLEX DR SUITE 401
TREVOSE PA
19053-6964
US

V. Phone/Fax

Practice location:
  • Phone: 864-848-3003
  • Fax: 864-848-7744
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
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number StateSC

VIII. Authorized Official

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