Provider Demographics
NPI:1598485765
Name:ACTIVE BEHAVIORAL CARE
Entity Type:Organization
Organization Name:ACTIVE BEHAVIORAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:ROJAS
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:626-494-9744
Mailing Address - Street 1:816 S CITRUS ST
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91791-3352
Mailing Address - Country:US
Mailing Address - Phone:626-494-9744
Mailing Address - Fax:
Practice Address - Street 1:816 S CITRUS ST
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91791-3352
Practice Address - Country:US
Practice Address - Phone:626-494-9744
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health