Provider Demographics
NPI:1235778762
Name:ACTIVE HOME CARE SERVICES INC
Entity Type:Organization
Organization Name:ACTIVE HOME CARE SERVICES INC
Other - Org Name:ACTIVE HOME CARE SERVICES INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHADRACK
Authorized Official - Middle Name:JORAM
Authorized Official - Last Name:BAMPEBUYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-763-2290
Mailing Address - Street 1:1700 ROCKVILLE PIKE STE 270A
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-1677
Mailing Address - Country:US
Mailing Address - Phone:240-542-4240
Mailing Address - Fax:
Practice Address - Street 1:1700 ROCKVILLE PIKE
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-1631
Practice Address - Country:US
Practice Address - Phone:240-542-4240
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-01
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Multi-Specialty