Provider Demographics
NPI:1659882066
Name:ACTIVE HOME CARE SERVICES INC
Entity Type:Organization
Organization Name:ACTIVE HOME CARE SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR / OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SHADRACK
Authorized Official - Middle Name:JORAM
Authorized Official - Last Name:BAMPEBUYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-683-4270
Mailing Address - Street 1:4600 POWDER MILL RD STE 450Z5
Mailing Address - Street 2:
Mailing Address - City:BELTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20705-2675
Mailing Address - Country:US
Mailing Address - Phone:240-542-4240
Mailing Address - Fax:240-542-4047
Practice Address - Street 1:1700 ROCKVILLE PIKE STE 270
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-1677
Practice Address - Country:US
Practice Address - Phone:240-542-4240
Practice Address - Fax:240-542-4047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-12
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No163WC1500XNursing Service ProvidersRegistered NurseCommunity HealthGroup - Multi-Specialty
No163WW0000XNursing Service ProvidersRegistered NurseWound CareGroup - Multi-Specialty
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Multi-Specialty
Yes3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, PediatricGroup - Multi-Specialty
No364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult HealthGroup - Multi-Specialty