Provider Demographics
NPI:1770191926
Name:ACTIVE HOME HEALTH CARE LLC
Entity Type:Organization
Organization Name:ACTIVE HOME HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHAFI
Authorized Official - Middle Name:
Authorized Official - Last Name:HOSEEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-209-2866
Mailing Address - Street 1:4848 S 76TH ST STE 200A
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53220-4361
Mailing Address - Country:US
Mailing Address - Phone:414-209-2866
Mailing Address - Fax:
Practice Address - Street 1:4848 S 76TH ST STE 200A
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53220-4361
Practice Address - Country:US
Practice Address - Phone:414-209-2866
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-14
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health