Provider Demographics
NPI:1053559583
Name:ACTIVE SENIORS UNLIMITED, INC.
Entity type:Organization
Organization Name:ACTIVE SENIORS UNLIMITED, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANN
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMIEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-330-0296
Mailing Address - Street 1:1140 WESTMONT DR
Mailing Address - Street 2:SUITE 415
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77015-4363
Mailing Address - Country:US
Mailing Address - Phone:713-330-0296
Mailing Address - Fax:
Practice Address - Street 1:1140 WESTMONT DR
Practice Address - Street 2:SUITE 415
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77015-4363
Practice Address - Country:US
Practice Address - Phone:713-330-0296
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-21
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child