Healthcare Provider Details

I. General information

NPI: 1053559583
Provider Name (Legal Business Name): ACTIVE SENIORS UNLIMITED, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2009
Last Update Date: 01/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 WESTMONT DR SUITE 415
HOUSTON TX
77015-4363
US

IV. Provider business mailing address

1140 WESTMONT DR SUITE 415
HOUSTON TX
77015-4363
US

V. Phone/Fax

Practice location:
  • Phone: 713-330-0296
  • Fax:
Mailing address:
  • Phone: 713-330-0296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: MRS. DIANN SIMIEN
Title or Position: PROGRAM MANAGER
Credential:
Phone: 713-330-0296