Provider Demographics
NPI:1225546484
Name:ACTIVE HEALTH, LLC
Entity Type:Organization
Organization Name:ACTIVE HEALTH, LLC
Other - Org Name:ACTIVE HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:PERKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-397-3230
Mailing Address - Street 1:1890 1ST CAPITOL DR UNIT 114
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63302-2105
Mailing Address - Country:US
Mailing Address - Phone:314-397-3230
Mailing Address - Fax:
Practice Address - Street 1:14449 JAMESTOWN BAY DR
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63034-1743
Practice Address - Country:US
Practice Address - Phone:314-397-3230
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-22
Last Update Date:2018-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOLC001563927253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care