Provider Demographics
NPI:1871995357
Name:ACTIVECARERX PROVIDERS, LLC
Entity type:Organization
Organization Name:ACTIVECARERX PROVIDERS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:CARAMANIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-512-1991
Mailing Address - Street 1:4504 SAN BLAS AVE
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-5429
Mailing Address - Country:US
Mailing Address - Phone:818-512-1991
Mailing Address - Fax:818-592-0494
Practice Address - Street 1:4504 SAN BLAS AVE
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-5429
Practice Address - Country:US
Practice Address - Phone:818-512-1991
Practice Address - Fax:818-592-0494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-16
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0904XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, Federal