Provider Demographics
NPI:1407531205
Name:ACTIVE HOME CARE SERVICES INC
Entity Type:Organization
Organization Name:ACTIVE HOME CARE SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:SHADRACK
Authorized Official - Middle Name:JORAM
Authorized Official - Last Name:BAMPEBUYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-683-4270
Mailing Address - Street 1:1700 ROCKVILLE PIKE STE 270B
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-1677
Mailing Address - Country:US
Mailing Address - Phone:240-542-4240
Mailing Address - Fax:240-542-4047
Practice Address - Street 1:1700 ROCKVILLE PIKE STE 270B
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-1677
Practice Address - Country:US
Practice Address - Phone:240-542-4240
Practice Address - Fax:240-542-4047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-19
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies