Provider Demographics
NPI:1003813064
Name:ACTIVE HEALTHCARE, INC.
Entity Type:Organization
Organization Name:ACTIVE HEALTHCARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:FEIERSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-870-8600
Mailing Address - Street 1:9650 STRICKLAND RD
Mailing Address - Street 2:SUITE 103-140
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-1902
Mailing Address - Country:US
Mailing Address - Phone:919-870-8600
Mailing Address - Fax:
Practice Address - Street 1:9104 FALLS OF NEUSE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-2408
Practice Address - Country:US
Practice Address - Phone:919-870-8600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-06
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC149332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7700598Medicaid
NC4551919OtherAETNA
NC0490ZOtherNC BCBS
NC82-09172OtherUNITED HEALTHCARE
NC0556430001Medicare ID - Type UnspecifiedMEDICARE DMERC-C