Provider Demographics
NPI:1558820266
Name:ACTIVE HEALTHCARE, INC.
Entity Type:Organization
Organization Name:ACTIVE HEALTHCARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:FEIERSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-870-8600
Mailing Address - Street 1:9104 FALLS OF NEUSE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-2494
Mailing Address - Country:US
Mailing Address - Phone:919-870-8600
Mailing Address - Fax:
Practice Address - Street 1:9104 FALLS OF NEUSE RD STE 100
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-2494
Practice Address - Country:US
Practice Address - Phone:919-870-1551
Practice Address - Fax:919-645-0020
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ACTIVE HEALTHCARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-03-13
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7700598Medicaid