Provider Demographics
NPI:1053787945
Name:ACTIVE HOME CARE LLC
Entity type:Organization
Organization Name:ACTIVE HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:RITZLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-501-2418
Mailing Address - Street 1:60 MEADOWBROOK CIR
Mailing Address - Street 2:APT 3
Mailing Address - City:NEW MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44442-9767
Mailing Address - Country:US
Mailing Address - Phone:330-501-2418
Mailing Address - Fax:
Practice Address - Street 1:721 BOARDMAN POLAND RD
Practice Address - Street 2:STE 102
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-5107
Practice Address - Country:US
Practice Address - Phone:330-501-2418
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-14
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care