# ACTIVE LIVING OSTOMY, INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** none
- **Organization subpart:** No

## Provider details

- **NPI number:** 1184736209
- **Authorized official:** MR. GIRMA LEGGESSE NONE (OWNER/PRESIDENT)
- **Authorized official phone:** (951) 808-9734

## Contact information

- **Practice address:** 994 THOROUGHBRED LN, NORCO, CA 92860-3861
- **Practice address phone:** (951) 808-9734
- **Practice address fax:** (951) 808-8603
- **Mailing address:** 994 THOROUGHBRED LN, NORCO, CA 92860-3861
- **Mailing address phone:** (951) 808-9734
- **Mailing address fax:** (951) 808-8603

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | 009039 | CA | Yes |

## Other

- **Enumeration date:** 08/31/2006
- **Last updated:** 09/06/2023