Provider Demographics
NPI:1467731539
Name:ACTIVE WAY HEALTHCARE SERVICES, LLC
Entity Type:Organization
Organization Name:ACTIVE WAY HEALTHCARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDI
Authorized Official - Middle Name:L
Authorized Official - Last Name:LAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-693-7665
Mailing Address - Street 1:3521 N CALIFORNIA AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61603-1171
Mailing Address - Country:US
Mailing Address - Phone:309-693-7665
Mailing Address - Fax:
Practice Address - Street 1:3521 N CALIFORNIA AVE
Practice Address - Street 2:SUITE C
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61603-1171
Practice Address - Country:US
Practice Address - Phone:309-693-7665
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-08
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care