Active Life, LLC

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

Legal business name

ACTIVE LIFE, LLC

Practice address

2140 W Chapman Ave
Suite 103
Orange, CA 92868-2331

Phone

(714) 602-6436

Fax

(714) 468-5148

NPI assigned

Dec 9, 2011

Last updated

Jan 24, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Pallavi Chintapalli Nemani

Title

Compliance Officer

Phone

(512) 552-6311

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jedidiah Andrew Jacobson, CPO

  • Orthotist
  • Orange, CA
  • NPI 1770099814
  NPD (past)

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

{
    "created_epoch": "1323388800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1674518400000",
    "number": "1689942294",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1577 E CHEVY CHASE DR",
            "address_2": "SUITE 210",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912064147",
            "telephone_number": "818-495-4610",
            "fax_number": "818-484-2812"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2140 W CHAPMAN AVE",
            "address_2": "SUITE 103",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928682331",
            "telephone_number": "714-602-6436",
            "fax_number": "714-468-5148"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACTIVE LIFE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-09",
        "last_updated": "2023-01-24",
        "certification_date": "2023-01-24",
        "status": "A",
        "authorized_official_last_name": "NEMANI",
        "authorized_official_first_name": "PALLAVI",
        "authorized_official_middle_name": "CHINTAPALLI",
        "authorized_official_title_or_position": "COMPLIANCE OFFICER",
        "authorized_official_telephone_number": "512-552-6311"
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "XC0009601",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDI CAL",
            "identifier": "XC0009601",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Karen Acosta
• Leslie Acosta
• Nestor Miguel Acosta
• Yesenia Acosta, ACSW
• Acs Med. Corp.
• Acuity Behavior Solutions LLC (Acuity Behavior Solutions)
• Brenda Acuna
• Acute Care Medical Group of Orange Inc
• Natalie Adair
• Elias S Adam, D.C.

• Prosthetic/Orthotic Supplier in Orange, CA
• Providers in Orange, CA by specialty
• Prosthetic/Orthotic Supplier in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2023; 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.