Provider Demographics
NPI:1467876763
Name:ACTIVE CARE HOME SERVICES, INC
Entity Type:Organization
Organization Name:ACTIVE CARE HOME SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-640-1802
Mailing Address - Street 1:4578 BEHLMANN GROVE PL
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63034-2860
Mailing Address - Country:US
Mailing Address - Phone:314-640-1802
Mailing Address - Fax:314-741-3799
Practice Address - Street 1:4578 BEHLMANN GROVE PL
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63034-2860
Practice Address - Country:US
Practice Address - Phone:314-640-1802
Practice Address - Fax:314-741-3799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-07
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty