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General NPI Number Information
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NPI Number | 1578604054
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Entity Type | Organization
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Legal Business Name | ACTIVE SC PCA, INC.
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Dates
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Enumeration Date | 02/09/2007
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Last Update Date | 09/09/2016
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Provider Practice Location Address
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Address Line | 228 N CREEK BLVD
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City | GREENWOOD
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State | SC
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Zip | 29649-9006
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Country | US
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Telephone | 864-953-2288
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Fax | 864-229-6522
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Provider Business Mailing Address
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Address Line | 6 NESHAMINY INTERPLEX DR SUITE 401
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City | TREVOSE
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State | PA
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Zip | 19053-6964
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Country | US
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Telephone | 215-642-6600
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Fax | 215-642-6610
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Authorized Official
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Title or Position | COO
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Name | CRAIG MEHNERT
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Credential |
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Telephone | 215-642-6600
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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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