Provider Demographics
NPI:1780294884
Name:ACTIVE LIVING PRODUCTS AND SERVICES
Entity type:Organization
Organization Name:ACTIVE LIVING PRODUCTS AND SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:KOMAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-515-1241
Mailing Address - Street 1:2620 BROWNSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15227-2061
Mailing Address - Country:US
Mailing Address - Phone:412-900-0098
Mailing Address - Fax:
Practice Address - Street 1:2620 BROWNSVILLE RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15227-2061
Practice Address - Country:US
Practice Address - Phone:412-900-0098
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-04
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies