Provider Demographics
NPI:1346960812
Name:ACTIVE SENIOR CARE INC.
Entity Type:Organization
Organization Name:ACTIVE SENIOR CARE INC.
Other - Org Name:TOWN SQUARE UNIVERSITY PARKWAY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:KINGSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-277-5048
Mailing Address - Street 1:3902 E STATE ROAD 64
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-9059
Mailing Address - Country:US
Mailing Address - Phone:941-277-5048
Mailing Address - Fax:
Practice Address - Street 1:8450 LOCKWOOD RIDGE RD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34243-2920
Practice Address - Country:US
Practice Address - Phone:941-277-5048
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-02
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care