Provider Demographics
NPI:1376794032
Name:ACTIVE CARE SERVICES
Entity Type:Organization
Organization Name:ACTIVE CARE SERVICES
Other - Org Name:PRO-ACTIVE CARE SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CECILIO
Authorized Official - Middle Name:CHIO
Authorized Official - Last Name:BANA
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:818-920-7147
Mailing Address - Street 1:14747 ROSCOE BLVD
Mailing Address - Street 2:#19
Mailing Address - City:PANORAMA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91402-4145
Mailing Address - Country:US
Mailing Address - Phone:818-920-7147
Mailing Address - Fax:
Practice Address - Street 1:14747 ROSCOE BLVD
Practice Address - Street 2:#19
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402-4145
Practice Address - Country:US
Practice Address - Phone:818-920-7147
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-30
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0002167408-0001-1251E00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health