Provider Demographics
NPI:1376581819
Name:ACTIVE MOBILITY OF OHIO INC
Entity Type:Organization
Organization Name:ACTIVE MOBILITY OF OHIO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:C
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-478-1881
Mailing Address - Street 1:5702 OPPORTUNITY DR
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43612-2903
Mailing Address - Country:US
Mailing Address - Phone:419-478-1881
Mailing Address - Fax:419-478-1919
Practice Address - Street 1:5702 OPPORTUNITY DR
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43612-2903
Practice Address - Country:US
Practice Address - Phone:419-478-1881
Practice Address - Fax:419-478-1919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH03073OtherPARAMOUNT HEALTH CARE
OH0508418Medicaid
MI873065395OtherMEDICAID
OH0279640001Medicare NSC
OH03073OtherPARAMOUNT HEALTH CARE