Provider Demographics
NPI:1235386566
Name:ACTIVE PERSONAL CARE SERVICES, LLC
Entity Type:Organization
Organization Name:ACTIVE PERSONAL CARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MYLAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BALDAUF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-883-0777
Mailing Address - Street 1:4593 E FIRESTONE DR
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85249-7383
Mailing Address - Country:US
Mailing Address - Phone:480-883-0777
Mailing Address - Fax:
Practice Address - Street 1:4593 E FIRESTONE DR
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85249-7383
Practice Address - Country:US
Practice Address - Phone:480-883-0777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-18
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health