Organization
ACTIVE LIFE MEDICAL MANAGEMENT
Active
Other names
Active Life Medical
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY SOUZA (PRESIDENT)
(318) 442-2200
Entity
Organization
Contact information
Practice address
4501 JACKSON ST, STE. C-322, ALEXANDRIA, LA 71303-2555
(318) 442-2200
(318) 442-2208
Mailing address
PO BOX 586, YUBA CITY, CA 95992-0586
(530) 455-5670
(530) 455-5669
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
332BC3200X
Customized Equipment (DME)
DME000481
LA
332BN1400X
Nursing Facility Supplies (DME)
DME000481
LA
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
DME000481
LA
332BX2000X
Oxygen Equipment & Supplies (DME)
DME000481
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DME000481
LA PHARMACY LICENSE
LA
Enumeration date
05/13/2015
Last updated
05/13/2015
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