Provider Demographics
NPI:1396021010
Name:ACTIVATE HEALTHCARE PC
Entity Type:Organization
Organization Name:ACTIVATE HEALTHCARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:A
Authorized Official - Last Name:GEIHSLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-455-9200
Mailing Address - Street 1:2115 N DAMEN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-4528
Mailing Address - Country:US
Mailing Address - Phone:773-697-3144
Mailing Address - Fax:
Practice Address - Street 1:6340 N EWING ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-4424
Practice Address - Country:US
Practice Address - Phone:773-697-3144
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-26
Last Update Date:2013-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency