Provider Demographics
| NPI: | 1447967658 |
|---|---|
| Name: | ACTIVE HEALTH SERVICES, INC |
| Entity type: | Organization |
| Organization Name: | ACTIVE HEALTH SERVICES, INC |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | CEO |
| Authorized Official - Prefix: | MR |
| Authorized Official - First Name: | SHADRACK |
| Authorized Official - Middle Name: | JORAM |
| Authorized Official - Last Name: | BAMPEBUYE |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 202-763-2290 |
| Mailing Address - Street 1: | 5722 LITTLE SPRING WAY |
| Mailing Address - Street 2: | |
| Mailing Address - City: | FREDERICK |
| Mailing Address - State: | MD |
| Mailing Address - Zip Code: | 21704-6704 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 202-763-2290 |
| Mailing Address - Fax: | |
| Practice Address - Street 1: | 2915 RHODE ISLAND AVE NE |
| Practice Address - Street 2: | |
| Practice Address - City: | WASHINGTON |
| Practice Address - State: | DC |
| Practice Address - Zip Code: | 20018-2943 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 202-763-2290 |
| Practice Address - Fax: | |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2022-10-28 |
| Last Update Date: | 2022-10-28 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | |
| No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Single Specialty |
| No | 172V00000X | Other Service Providers | Community Health Worker | Group - Single Specialty | |
| No | 251E00000X | Agencies | Home Health | ||
| No | 261QM0850X | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health | |
| No | 261QR0405X | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder | |
| No | 320900000X | Residential Treatment Facilities | Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | ||
| No | 324500000X | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility | ||
| No | 3245S0500X | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility | Substance Abuse Treatment, Children | |
| No | 385HR2060X | Respite Care Facility | Respite Care | Respite Care, Intellectual and/or Developmental Disabilities, Child |
