Provider Demographics
NPI:1053186320
Name:ACTIVE SENIOR FITNESS & COMPANION LLC
Entity type:Organization
Organization Name:ACTIVE SENIOR FITNESS & COMPANION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AMBR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:RITTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-623-7900
Mailing Address - Street 1:12278 23RD ST E
Mailing Address - Street 2:
Mailing Address - City:PARRISH
Mailing Address - State:FL
Mailing Address - Zip Code:34219-6900
Mailing Address - Country:US
Mailing Address - Phone:941-623-7900
Mailing Address - Fax:
Practice Address - Street 1:5225 33RD ST E
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34203-4330
Practice Address - Country:US
Practice Address - Phone:941-623-7900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-16
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care