MEDICARE: ACITVE DAY IN, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD1600X	Developmental Disabilities Clinic/Center
2	261QA0600X	Adult Day Care Clinic/Center

General Provider Information

NPI Number	:	1124952932
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACITVE DAY IN, INC.

Provider Business Mailing Address
First Line	:	6 INTERPLEX DR STE 401
Second Line	:
City	:	TREVOSE
State	:	PA
Zip	:	19053-6942
Country	:	US
Telephone Number	:	215-642-6600
Fax Number	:

Provider Business Practice Location Address
First Line	:	2225 SHELBY ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46203-4260
Country	:	US
Telephone Number	:	317-296-8811
Fax Number	:

Authorized Official
Title or Position	:	MANAGER OF CONTRACTS AND LICENSING
Name	:	SELENA DAWN DESHAZOR
Credential	:
Telephone Number	:	215-642-6600

Provider Enumeration Date	:	06/09/2026
Last Update Date	:	06/10/2026

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