Active Community Support

Primary specialty

Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X

Legal business name

ACTIVE COMMUNITY SUPPORT

Practice address

3505 W Moreland Rd
Willow Grove, PA 19090-3831

Phone

(484) 350-0075

NPI assigned

Nov 18, 2019

Organization subpart

No

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

Authorized official

Name

Charles K Nyaga, DR

Title

Executive Director

Phone

(484) 350-0075

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1574035200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1574035200000",
    "number": "1326684010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3505 W MORELAND RD",
            "city": "WILLOW GROVE",
            "state": "PA",
            "postal_code": "190903831",
            "telephone_number": "484-350-0075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3505 W MORELAND RD",
            "city": "WILLOW GROVE",
            "state": "PA",
            "postal_code": "190903831",
            "telephone_number": "484-350-0075"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACTIVE COMMUNITY SUPPORT",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-11-18",
        "last_updated": "2019-11-18",
        "status": "A",
        "authorized_official_last_name": "NYAGA",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "484-350-0075",
        "authorized_official_credential": "DR"
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2019; 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.