Provider Demographics
NPI:1679030704
Name:ACTIVE HOME CARE SERVICES, LLC
Entity Type:Organization
Organization Name:ACTIVE HOME CARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ABDIAZIZ
Authorized Official - Middle Name:OMAR
Authorized Official - Last Name:HUSSEIN
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:571-277-0173
Mailing Address - Street 1:5613 LEESBURG PIKE STE 7
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22041-2912
Mailing Address - Country:US
Mailing Address - Phone:571-277-0173
Mailing Address - Fax:703-852-4436
Practice Address - Street 1:5613 LEESBURG PIKE STE 7
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22041-2912
Practice Address - Country:US
Practice Address - Phone:571-277-0173
Practice Address - Fax:703-852-4436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-25
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No385H00000XRespite Care FacilityRespite CareGroup - Multi-Specialty