Provider Demographics
NPI:1467166249
Name:ACTIVE SC ONE, INC.
Entity Type:Organization
Organization Name:ACTIVE SC ONE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGULATORY AND CONTRACT ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:VANSCHAICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-642-6600
Mailing Address - Street 1:6 INTERPLEX DR STE 401
Mailing Address - Street 2:
Mailing Address - City:TREVOSE
Mailing Address - State:PA
Mailing Address - Zip Code:19053-6942
Mailing Address - Country:US
Mailing Address - Phone:267-917-6899
Mailing Address - Fax:
Practice Address - Street 1:3532 LEAPHART RD
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-3032
Practice Address - Country:US
Practice Address - Phone:803-791-3256
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-06
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care