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General NPI Number Information
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NPI Number | 1356134258
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Entity Type | Organization
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Legal Business Name | ACTIVE HOME CARE REHABILITATION SERVICES INC
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Dates
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Enumeration Date | 05/23/2025
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Last Update Date | 05/23/2025
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Provider Practice Location Address
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Address Line | 9211 CORPORATE BLVD STE 255
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City | ROCKVILLE
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State | MD
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Zip | 20850-3856
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Country | US
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Telephone | 240-238-1110
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Fax | 240-238-1112
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Provider Business Mailing Address
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Address Line | 9211 CORPORATE BLVD STE 255
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City | ROCKVILLE
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State | MD
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Zip | 20850-3856
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Country | US
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Telephone | 240-238-1110
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Fax | 240-238-1112
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Authorized Official
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Title or Position | CEO
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Name | SHADRACK JORAM BAMPEBUYE
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Credential |
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Telephone | 202-763-2290
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QI0500X
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Taxonomy Name | Infusion Therapy Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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