Provider Demographics
NPI:1083782155
Name:ACTIVECARE NETWORK, LLC
Entity Type:Organization
Organization Name:ACTIVECARE NETWORK, LLC
Other - Org Name:ACTIVECARE NETWORK
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:JUDI
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:GRUPP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-267-9400
Mailing Address - Street 1:2275 HALF DAY RD
Mailing Address - Street 2:SUITE 333
Mailing Address - City:BANNOCKBURN
Mailing Address - State:IL
Mailing Address - Zip Code:60015-1217
Mailing Address - Country:US
Mailing Address - Phone:847-267-9400
Mailing Address - Fax:847-267-9411
Practice Address - Street 1:2275 HALF DAY RD
Practice Address - Street 2:SUITE 333
Practice Address - City:BANNOCKBURN
Practice Address - State:IL
Practice Address - Zip Code:60015-1217
Practice Address - Country:US
Practice Address - Phone:847-267-9400
Practice Address - Fax:847-267-9411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site