Provider Demographics
NPI:1356829105
Name:5TH GENERATION INC D/B/A ACTI-KARE RESPONSIVE IN-HOME CARE
Entity Type:Organization
Organization Name:5TH GENERATION INC D/B/A ACTI-KARE RESPONSIVE IN-HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AREA DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:INDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-272-6103
Mailing Address - Street 1:9050 PINES BLVD STE 415-409
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-6455
Mailing Address - Country:US
Mailing Address - Phone:954-272-6103
Mailing Address - Fax:954-637-1888
Practice Address - Street 1:9050 PINES BLVD STE 415-409
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-6455
Practice Address - Country:US
Practice Address - Phone:954-272-6103
Practice Address - Fax:954-637-1888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-03
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL29994797251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101133500Medicaid