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NPI Code Detail

MEDICARE: ACTIVE HEALTHCARE, INC.

MEDICARE: ACTIVE HEALTHCARE, 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
1332B00000XDurable Medical Equipment & Medical Supplies

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1356851299
Entity Type Code : Organization
Provider Name (Legal Business Name) : ACTIVE HEALTHCARE, INC.
Provider Business Mailing Address
First Line : 9650 STRICKLAND RD # 103-140
Second Line :
City : RALEIGH
State : NC
Zip : 27615-1902
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 11709 FRUEHAUF DR
Second Line :
City : CHARLOTTE
State : NC
Zip : 28273-7284
Country : US
Telephone Number : 919-870-8600
Fax Number :
Authorized Official
Title or Position : CONTROLLER
Name : LISA ELAINE ELLISON
Credential :
Telephone Number : 919-870-8600
Provider Enumeration Date : 10/05/2017
Last Update Date : 10/05/2017

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Directions to “ACTIVE HEALTHCARE, INC. ” Practice Location

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