Provider Demographics
NPI:1841742434
Name:ACTIVE AT HOME HELPERS
Entity Type:Organization
Organization Name:ACTIVE AT HOME HELPERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRET
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:THISETH
Authorized Official - Suffix:I
Authorized Official - Credentials:
Authorized Official - Phone:701-540-3483
Mailing Address - Street 1:417 MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-1956
Mailing Address - Country:US
Mailing Address - Phone:701-540-3483
Mailing Address - Fax:
Practice Address - Street 1:417 MAIN AVE
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-1956
Practice Address - Country:US
Practice Address - Phone:701-540-3483
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-29
Last Update Date:2016-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1456069251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health