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General NPI Number Information
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NPI Number | 1760613889
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Entity Type | Organization
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Legal Business Name | ACTIVE FAMILY SOLUTIONS
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Dates
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Enumeration Date | 08/06/2009
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Last Update Date | 08/06/2009
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Provider Practice Location Address
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Address Line | 13327 N 152ND AVE
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City | SURPRISE
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State | AZ
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Zip | 85379-9119
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Country | US
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Telephone | 602-769-2532
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Fax |
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Provider Business Mailing Address
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Address Line | 13327 N 152ND AVE
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City | SURPRISE
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State | AZ
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Zip | 85379-9119
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Country | US
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Telephone | 602-769-2532
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. RICHARD G GLENNRELLER
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Credential | OTR
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Telephone | 602-769-2532
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number | 3836
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License Number State | AZ
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