Provider Demographics
NPI:1295256980
Name:ACTIVE MA, INC.
Entity type:Organization
Organization Name:ACTIVE MA, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:O
Authorized Official - Last Name:MEHNERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-642-6600
Mailing Address - Street 1:6 NESHAMINY INTERPLEX DR STE 401
Mailing Address - Street 2:
Mailing Address - City:TREVOSE
Mailing Address - State:PA
Mailing Address - Zip Code:19053-6942
Mailing Address - Country:US
Mailing Address - Phone:215-642-6600
Mailing Address - Fax:215-642-6610
Practice Address - Street 1:81 WELBY RD
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02745-1118
Practice Address - Country:US
Practice Address - Phone:508-985-9076
Practice Address - Fax:508-985-6026
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ACTIVE DAY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-07-03
Last Update Date:2017-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care