Organization
A1 ACTIVE CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ANDREW M LACY SR. (MEMBER)
(678) 230-7095
Entity
Organization
Contact information
Practice address
1016 W JACKSON BLVD, CHICAGO, IL 60607-2914
(312) 675-8471
(312) 488-3648
Mailing address
1016 W JACKSON BLVD, CHICAGO, IL 60607-2914
(312) 675-8471
(312) 675-8471
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
Other
Enumeration date
10/01/2014
Last updated
12/02/2016
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