Provider Demographics
NPI:1336401959
Name:ACTIVE HOME HEALTH INC
Entity Type:Organization
Organization Name:ACTIVE HOME HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF NURSING
Authorized Official - Prefix:MRS
Authorized Official - First Name:SOPHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:FUNKENSHTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-564-9999
Mailing Address - Street 1:2970 MARIA AVE, SUITE 210
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062
Mailing Address - Country:US
Mailing Address - Phone:847-567-3937
Mailing Address - Fax:847-564-9160
Practice Address - Street 1:2970 MARIA AVE, SUITE 210
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062
Practice Address - Country:US
Practice Address - Phone:847-567-3937
Practice Address - Fax:847-564-9160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-10
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health