MEDICARE: ACTIVE CARE SERVICES

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	253Z00000X	In Home Supportive Care Agency	0002167408-0001-1	CA
2	251E00000X	Home Health Agency	0002167408-0001-1	CA

General Provider Information

NPI Number	:	1134370760
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACTIVE CARE SERVICES

Provider Business Mailing Address
First Line	:	14747 ROSCOE BLVD
Second Line	:	#19
City	:	PANORAMA CITY
State	:	CA
Zip	:	91402-4145
Country	:	US
Telephone Number	:	818-920-7147
Fax Number	:

Provider Business Practice Location Address
First Line	:	14747 ROSCOE BLVD
Second Line	:	#19
City	:	PANORAMA CITY
State	:	CA
Zip	:	91402-4145
Country	:	US
Telephone Number	:	818-920-7147
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. CECILIO CHIO BANA JR.
Credential	:
Telephone Number	:	818-920-7147

Provider Enumeration Date	:	10/01/2008
Last Update Date	:	10/01/2008

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