Provider Demographics
NPI:1508364266
Name:ACTIVE ASSIST HOME CARE SERVICES LLC
Entity Type:Organization
Organization Name:ACTIVE ASSIST HOME CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:T
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-374-1580
Mailing Address - Street 1:135 TREELINE DR
Mailing Address - Street 2:
Mailing Address - City:DEPTFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-6688
Mailing Address - Country:US
Mailing Address - Phone:856-374-1580
Mailing Address - Fax:
Practice Address - Street 1:11 ENTERPRISE CT UNIT 8
Practice Address - Street 2:
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-4112
Practice Address - Country:US
Practice Address - Phone:856-374-1580
Practice Address - Fax:856-374-1112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-29
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
NJHP0270200251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health