MEDICARE: ACTIVE SOLUTIONS INCORPORATED

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	251C00000X	Developmentally Disabled Services Day Training Agency	000A0991	NM

General Provider Information

NPI Number	:	1174655617
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACTIVE SOLUTIONS INCORPORATED

Provider Business Mailing Address
First Line	:	2730 SAN PEDRO DR NE
Second Line	:	SUITE H
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-3334
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2730 SAN PEDRO DR NE
Second Line	:	SUITE H
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-3334
Country	:	US
Telephone Number	:	505-830-9291
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. TODD T. JOHNSON
Credential	:
Telephone Number	:	505-830-9291

Provider Enumeration Date	:	03/11/2007
Last Update Date	:	08/22/2020

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