Provider Demographics
NPI:1225527690
Name:PROACTIVE HEALTH CENTER, CORP.
Entity Type:Organization
Organization Name:PROACTIVE HEALTH CENTER, CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:OTTO
Authorized Official - Middle Name:
Authorized Official - Last Name:MARQUES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-200-1970
Mailing Address - Street 1:3400 LEE BLVD UNIT 111
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33971-1309
Mailing Address - Country:US
Mailing Address - Phone:239-200-1970
Mailing Address - Fax:
Practice Address - Street 1:3400 LEE BLVD UNIT 111
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33971-1309
Practice Address - Country:US
Practice Address - Phone:239-200-1970
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-01
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management