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General NPI Number Information
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NPI Number | 1902009079
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Entity Type | Organization
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Legal Business Name | PROACTIVE ASSOCIATES, LLC
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Dates
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Enumeration Date | 06/07/2007
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Last Update Date | 12/08/2021
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Provider Practice Location Address
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Address Line | 3450 N ROCK ROAD 213
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City | WICHITA
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State | KS
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Zip | 67226-1352
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Country | US
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Telephone | 316-688-5511
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Fax | 316-688-1081
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Provider Business Mailing Address
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Address Line | 2450 N ROCK ROAD SUITE # 213, ATTN: DEBRA MULLEN
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City | WICHITA
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State | KS
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Zip | 67060
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Country | US
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Telephone | 316-688-5511
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Fax |
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Authorized Official
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Title or Position | PRESIDENT & SECRETARY
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Name | GEORGE SCOTT HERMAN
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Credential |
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Telephone | 512-632-7156
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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 | A087065
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License Number State | KS
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