Provider Demographics
NPI:1558541144
Name:ACTIVE HOME HEALTH CARE SERVICES,LLC
Entity Type:Organization
Organization Name:ACTIVE HOME HEALTH CARE SERVICES,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CONRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAGUIRRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-968-5553
Mailing Address - Street 1:5589 OKEECHOBEE BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33417-4486
Mailing Address - Country:US
Mailing Address - Phone:561-968-5553
Mailing Address - Fax:561-300-2115
Practice Address - Street 1:5589 OKEECHOBEE BLVD STE 105
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33417-4486
Practice Address - Country:US
Practice Address - Phone:561-968-5553
Practice Address - Fax:561-300-2115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-12
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299992941251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health