Provider Demographics
NPI:1184402950
Name:ACTIVE FRIENDLY CARE LLC
Entity type:Organization
Organization Name:ACTIVE FRIENDLY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-975-8743
Mailing Address - Street 1:2432 W PEORIA AVE STE 1227
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-4737
Mailing Address - Country:US
Mailing Address - Phone:602-975-8743
Mailing Address - Fax:
Practice Address - Street 1:2511 W INDIAN SCHOOL RD STE 1043
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85017-4302
Practice Address - Country:US
Practice Address - Phone:602-975-8743
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-21
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center