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General NPI Number Information
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NPI Number | 1932583267
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Entity Type | Organization
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Legal Business Name | PROACTIVE HEALTHCARE SERVICES, LLC
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Dates
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Enumeration Date | 07/16/2015
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Last Update Date | 07/16/2015
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Provider Practice Location Address
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Address Line | 5700 KIRKWOOD HWY SUITE 105A
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City | WILMINGTON
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State | DE
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Zip | 19808-4857
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Country | US
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Telephone | 877-452-9944
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Fax | 302-370-5002
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Provider Business Mailing Address
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Address Line | 5700 KIRKWOOD HWY SUITE 105 A
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City | WILMINGTON
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State | DE
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Zip | 19808-4857
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Country | US
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Telephone | 877-451-9944
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Fax | 484-540-8391
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Authorized Official
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Title or Position | PRESIDENT
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Name | MISS RACHEAL CHRISTIANA BUNDOR
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Credential | LPN
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Telephone | 18774519944
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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 | HHAS-059
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License Number State | DE
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