Active Home Healthcare Inc

Primary specialty

Home Health AideTaxonomy code 374U00000X

Legal business name

ACTIVE HOME HEALTHCARE INC

Practice address

2108 Altoona Rd
Bloomington, IL 61705-4143

Phone

(309) 838-5772

NPI assigned

Aug 5, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Wyndy Jenkins

Title

President/Ceo

Phone

(309) 838-5772

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1628121600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1628121600000",
    "number": "1215601976",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2108 ALTOONA RD",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617054143",
            "telephone_number": "309-838-5772"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2108 ALTOONA RD",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617054143",
            "telephone_number": "309-838-5772"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACTIVE HOME HEALTHCARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-05",
        "last_updated": "2021-08-05",
        "certification_date": "2021-08-05",
        "status": "A",
        "authorized_official_last_name": "JENKINS",
        "authorized_official_first_name": "WYNDY",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "309-838-5772"
    },
    "taxonomies": [
        {
            "code": "374U00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Home Health Aide",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in Bloomington, IL
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.