MEDICARE: ACTIVECARE

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	333300000X	Emergency Response System Companies	333300000X	UT

Other Identifiers

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

General Provider Information

NPI Number	:	1629346234
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACTIVECARE

Provider Business Mailing Address
First Line	:	4897 LAKE PARK BLVD STE 140
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84120-8211
Country	:	US
Telephone Number	:	801-895-2640
Fax Number	:

Provider Business Practice Location Address
First Line	:	4897 LAKE PARK BLVD STE 140
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84120-8211
Country	:	US
Telephone Number	:	801-895-2640
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	MR. MIKE ACTON
Credential	:
Telephone Number	:	801-895-2640

Provider Enumeration Date	:	12/09/2011
Last Update Date	:	12/09/2011

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Directions to “ACTIVECARE ” Practice Location

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