Provider Demographics
NPI:1134284375
Name:ACTIVE HOME MEDICAL SUPPLY INC.
Entity Type:Organization
Organization Name:ACTIVE HOME MEDICAL SUPPLY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:MARGARET
Authorized Official - Last Name:SEARS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-667-6962
Mailing Address - Street 1:655 MCCORMICK DR STE A
Mailing Address - Street 2:
Mailing Address - City:LAPEER
Mailing Address - State:MI
Mailing Address - Zip Code:48446-3922
Mailing Address - Country:US
Mailing Address - Phone:810-667-6962
Mailing Address - Fax:810-667-9204
Practice Address - Street 1:655 MCCORMICK DR STE A
Practice Address - Street 2:
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-3922
Practice Address - Country:US
Practice Address - Phone:810-667-6962
Practice Address - Fax:810-667-9204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Not Answered332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
Not Answered332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Not Answered332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Not Answered335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI540D41147OtherBLUE CROSS BLUE SHIELD
0234590001Medicare ID - Type Unspecified