Provider Demographics
NPI:1720603418
Name:ACTIVE LIFE HEALTH OF COLUMBUS LLC
Entity Type:Organization
Organization Name:ACTIVE LIFE HEALTH OF COLUMBUS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN & CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:RUSH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-928-1697
Mailing Address - Street 1:6325 EMERALD PKWY STE 2B
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-3241
Mailing Address - Country:US
Mailing Address - Phone:614-504-0741
Mailing Address - Fax:
Practice Address - Street 1:6325 EMERALD PKWY STE 2B
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43016-3241
Practice Address - Country:US
Practice Address - Phone:614-504-0741
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-09
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty