Provider Demographics
NPI:1336144039
Name:ACTIVE HOME CARE SERVICES, INC.
Entity Type:Organization
Organization Name:ACTIVE HOME CARE SERVICES, INC.
Other - Org Name:ACTIVE HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CIULLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-686-4663
Mailing Address - Street 1:1016 N INDUSTRIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:PILOT POINT
Mailing Address - State:TX
Mailing Address - Zip Code:76258-2924
Mailing Address - Country:US
Mailing Address - Phone:940-686-4663
Mailing Address - Fax:940-686-0146
Practice Address - Street 1:1016 N INDUSTRIAL BLVD
Practice Address - Street 2:
Practice Address - City:PILOT POINT
Practice Address - State:TX
Practice Address - Zip Code:76258
Practice Address - Country:US
Practice Address - Phone:940-686-4663
Practice Address - Fax:940-686-0146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-17
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX017938251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX101928OtherAMERIGROUP PROVIDER #
TX148074101Medicaid
TX148074101Medicaid
TX679106Medicare Oscar/Certification