Provider Demographics
NPI:1821491010
Name:A1 ACTIVE CARE
Entity Type:Organization
Organization Name:A1 ACTIVE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:M
Authorized Official - Last Name:LACY
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:678-230-7095
Mailing Address - Street 1:1016 W JACKSON BLVD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-2914
Mailing Address - Country:US
Mailing Address - Phone:312-675-8471
Mailing Address - Fax:312-675-8471
Practice Address - Street 1:1016 W JACKSON BLVD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-2914
Practice Address - Country:US
Practice Address - Phone:312-675-8471
Practice Address - Fax:312-488-3648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-01
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health