Provider Demographics
NPI:1932583267
Name:PROACTIVE HEALTHCARE SERVICES, LLC
Entity Type:Organization
Organization Name:PROACTIVE HEALTHCARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:RACHEAL
Authorized Official - Middle Name:CHRISTIANA
Authorized Official - Last Name:BUNDOR
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:1877-451-9944
Mailing Address - Street 1:5700 KIRKWOOD HWY
Mailing Address - Street 2:SUITE 105 A
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-4857
Mailing Address - Country:US
Mailing Address - Phone:877-451-9944
Mailing Address - Fax:484-540-8391
Practice Address - Street 1:5700 KIRKWOOD HWY
Practice Address - Street 2:SUITE 105A
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-4857
Practice Address - Country:US
Practice Address - Phone:877-452-9944
Practice Address - Fax:302-370-5002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-16
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEHHAS-059251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health