Provider Demographics
NPI:1881439495
Name:ACTIVE ANGEL CARE LLC
Entity type:Organization
Organization Name:ACTIVE ANGEL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:FARIDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ULANDER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:513-535-5040
Mailing Address - Street 1:5195 CLEVES WARSAW PIKE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45238-3864
Mailing Address - Country:US
Mailing Address - Phone:513-620-5911
Mailing Address - Fax:
Practice Address - Street 1:5195 CLEVES WARSAW PIKE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45238-3864
Practice Address - Country:US
Practice Address - Phone:513-620-5911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-26
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0080585Medicaid