Healthcare Provider Details

I. General information

NPI: 1487686879
Provider Name (Legal Business Name): ACTIVE LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 W CHURCH AVE SUITE A
MEDINA TN
38355-8769
US

IV. Provider business mailing address

PO BOX 444
MEDINA TN
38355-0444
US

V. Phone/Fax

Practice location:
  • Phone: 731-783-1975
  • Fax: 731-723-1148
Mailing address:
  • Phone: 731-783-1975
  • Fax: 731-723-1148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name: JOAN G ARNOLD
Title or Position: OWNER
Credential: LPC
Phone: 731-783-1975