Active Home Care LLC

Key facts

NPI

1730312232

Entity type

Organization (NPI type 2)

Primary specialty

Durable Medical Equipment & Medical Supplies 332B00000X

License

69000564A (IN)

Legal business name

ACTIVE HOME CARE LLC

Practice address

5980 W 71St St
Suite 203
Indianapolis, IN 46278-2711

Phone

(317) 328-2866

Fax

(317) 534-0578

NPI assigned

Aug 31, 2009

Organization subpart

No

Authorized official

Name

Mr. Richard L Johnson

Title

President

Phone

(317) 328-2866

National Provider Directory

Locations

Specialties & licenses

Addresses

Other identifiers

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Feb 24, 2014.

{
    "created_epoch": "1251676800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1393200000000",
    "number": "1730312232",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5980 W 71ST ST",
            "address_2": "SUITE 203",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462782711",
            "telephone_number": "317-328-2866",
            "fax_number": "317-534-0578"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5980 W 71ST ST",
            "address_2": "SUITE 203",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462782711",
            "telephone_number": "317-328-2866",
            "fax_number": "317-534-0578"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACTIVE HOME CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-08-31",
        "last_updated": "2014-02-24",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "317-328-2866",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "IN",
            "license": "69000564A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200999000",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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