Organization Name: | ACTIVE MA, INC. |
NPI Number: | 1003957200 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | CRAIG MEHNERT (COO) |
Mailing Address: | 107 Welby Rd New Bedford |
State: | MA US |
Postal Code: | 027451135 |
Phone Number: | 5089988100 |
Fax Number: | 5089988163 |
NPI Enumeration Date: | 02/09/2007 |
NPI Last Update Date: | 01/27/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 385H00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | MA |
Taxonomy Type: | Respite Care Facility |
Taxonomy Classification: | Respite Care |
Taxonomy Specialization: | |
Taxonomy Definition: |