MEDICARE: ACTIVE PERSONAL CARE SERVICES, LLC

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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1235386566
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACTIVE PERSONAL CARE SERVICES, LLC

Provider Business Mailing Address
First Line	:	4593 E FIRESTONE DR
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85249-7383
Country	:	US
Telephone Number	:	480-883-0777
Fax Number	:

Provider Business Practice Location Address
First Line	:	4593 E FIRESTONE DR
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85249-7383
Country	:	US
Telephone Number	:	480-883-0777
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MYLAINE BALDAUF
Credential	:
Telephone Number	:	480-883-0777

Provider Enumeration Date	:	08/18/2008
Last Update Date	:	08/18/2008

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