1437592417 NPI number — ACTIVEHEALTHRX, INC

Table of content: (NPI 1437592417)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437592417 NPI number — ACTIVEHEALTHRX, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ACTIVEHEALTHRX, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437592417
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/23/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8500 WILSHIRE BLVD
Provider Second Line Business Mailing Address:
PH
Provider Business Mailing Address City Name:
BEVERLY HILLS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90211-3121
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-652-0085
Provider Business Mailing Address Fax Number:
866-390-0007

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8500 WILSHIRE BLVD
Provider Second Line Business Practice Location Address:
PH
Provider Business Practice Location Address City Name:
BEVERLY HILLS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90211-3121
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-652-0085
Provider Business Practice Location Address Fax Number:
866-390-0007
Provider Enumeration Date:
04/09/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LICHTWARDT
Authorized Official First Name:
IAN
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
310-741-7799

Provider Taxonomy Codes

  • Taxonomy code: 246RP1900X , with the licence number:  CPT54625 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QH0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)