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General NPI Number Information
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NPI Number | 1699236885
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Entity Type | Organization
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Legal Business Name | BE ACTIVE INC
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Dates
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Enumeration Date | 03/29/2019
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Last Update Date | 03/29/2019
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Provider Practice Location Address
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Address Line | 160 SCENIC DR
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City | PRATTVILLE
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State | AL
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Zip | 36066-6416
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Country | US
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Telephone | 334-231-4441
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Fax | 334-380-3723
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Provider Business Mailing Address
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Address Line | 160 SCENIC DR
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City | PRATTVILLE
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State | AL
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Zip | 36066-6416
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Country | US
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Telephone | 334-231-4441
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Fax | 334-380-3723
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Authorized Official
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Title or Position | OWNER/EXECUTIVE DIRECTOR
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Name | STEPHANIE BRADLEY
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Credential |
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Telephone | 334-717-1899
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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