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General NPI Number Information
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NPI Number | 1326955600
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Entity Type | Organization
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Legal Business Name | ACTIVE GLORY HEALTH CARE
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Dates
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Enumeration Date | 08/25/2026
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Last Update Date | 08/25/2026
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Provider Practice Location Address
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Address Line | 901 10TH ST S
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City | FARGO
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State | ND
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Zip | 58103-3101
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Country | US
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Telephone | 386-315-1170
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Fax |
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Provider Business Mailing Address
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Address Line | 901 10TH ST S
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City | FARGO
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State | ND
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Zip | 58103-3101
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Country | US
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Telephone | 386-315-1170
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Fax |
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Authorized Official
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Title or Position | CEO/FOUNDER
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Name | MISS JANET JENEBA MASON
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Credential | CNA
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Telephone | 386-315-1170
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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