Organization
ACTIVE HOME CARE LLC
Active
Organization
ACTIVE HOME CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RICHARD L JOHNSON (PRESIDENT)
(317) 328-2866
Entity
Organization
Contact information
Practice address
5980 W 71ST ST, SUITE 203, INDIANAPOLIS, IN 46278-2711
(317) 328-2866
(317) 534-0578
Mailing address
5980 W 71ST ST, SUITE 203, INDIANAPOLIS, IN 46278-2711
(317) 328-2866
(317) 534-0578
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
69000564A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200999000
—
IN
Enumeration date
08/31/2009
Last updated
02/24/2014
Update your record
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