Provider Demographics
NPI:1588613475
Name:ACTIVE CARE CENTER SC
Entity Type:Organization
Organization Name:ACTIVE CARE CENTER SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:PAWLUSIEWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:847-670-1111
Mailing Address - Street 1:609 N MAIN ST STE 101
Mailing Address - Street 2:
Mailing Address - City:MOUNT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-2160
Mailing Address - Country:US
Mailing Address - Phone:847-922-1142
Mailing Address - Fax:847-670-1113
Practice Address - Street 1:609 N MAIN ST STE 101
Practice Address - Street 2:
Practice Address - City:MOUNT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-2160
Practice Address - Country:US
Practice Address - Phone:847-670-1111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038009733111NX0800X
IL070012652225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U98705Medicare UPIN
U98705Medicare UPIN