Provider Demographics
NPI:1669857025
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 1:1430 N ARLINGTON HEIGHTS RD
Mailing Address - Street 2:201
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-4830
Mailing Address - Country:US
Mailing Address - Phone:847-670-1111
Mailing Address - Fax:847-670-1113
Practice Address - Street 1:1430 N ARLINGTON HEIGHTS RD
Practice Address - Street 2:201
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-4830
Practice Address - Country:US
Practice Address - Phone:847-670-1111
Practice Address - Fax:847-670-1113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-28
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038009733111NX0800X
IL070012652225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty