Provider Demographics
NPI:1942359146
Name:ACTIVE HOME HEALTH SVC., INC.
Entity Type:Organization
Organization Name:ACTIVE HOME HEALTH SVC., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO/SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:ROMEO
Authorized Official - Middle Name:
Authorized Official - Last Name:ANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-994-1534
Mailing Address - Street 1:6481 ORANGETHORPE AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90620-1376
Mailing Address - Country:US
Mailing Address - Phone:714-994-1534
Mailing Address - Fax:714-994-1564
Practice Address - Street 1:6481 ORANGETHORPE AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90620-1376
Practice Address - Country:US
Practice Address - Phone:714-994-1534
Practice Address - Fax:714-994-1564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA060000943251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA060000943OtherSTATE LICENSE
CA060000943OtherSTATE LICENSE