Provider Demographics
NPI:1922397322
Name:PRO ACTIVE HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:PRO ACTIVE HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF NURSING
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARIFFA HANNA
Authorized Official - Middle Name:F
Authorized Official - Last Name:MOHAMMAD
Authorized Official - Suffix:
Authorized Official - Credentials:BSN RN
Authorized Official - Phone:773-507-6464
Mailing Address - Street 1:4350 OAKTON ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-3270
Mailing Address - Country:US
Mailing Address - Phone:773-507-6464
Mailing Address - Fax:
Practice Address - Street 1:4350 OAKTON STREET
Practice Address - Street 2:SUITE 206
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-3270
Practice Address - Country:US
Practice Address - Phone:773-507-6464
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-06
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL163W00000XOtherTAXONOMY CODE FOR NURSING