Healthcare Provider Details

I. General information

NPI: 1730223751
Provider Name (Legal Business Name): ACTIVE SC PCA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 09/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 OSWEGO HWY
SUMTER SC
29153-8733
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 803-436-7420
  • Fax: 803-436-7423
Mailing address:
  • Phone: 215-642-6600
  • Fax: 215-642-6610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: CRAIG MEHNERT
Title or Position: COO
Credential:
Phone: 215-642-6600