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General NPI Number Information
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NPI Number | 1679182729
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Entity Type | Organization
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Legal Business Name | ACTIVE LIFE MD
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Dates
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Enumeration Date | 07/24/2020
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Last Update Date | 07/24/2020
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Provider Practice Location Address
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Address Line | 336 S MAIN ST # 2D-D
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City | BEL AIR
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State | MD
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Zip | 21014-3978
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Country | US
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Telephone | 877-700-5020
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Fax |
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Provider Business Mailing Address
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Address Line | 336 S MAIN ST # 2D-D
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City | BEL AIR
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State | MD
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Zip | 21014-3978
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | ARUT BALUYAN
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Credential |
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Telephone | 877-700-5020
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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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