Basic Information
| Provider Information | |||||||||
| NPI: | 1013648252 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ACTIVE SC ONE, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6 NESHAMINY INTERPLEX, STE 401 | ||||||||
| Address2: | |||||||||
| City: | TREVOSE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190536942 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2156426600 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1111 STATE ST | ||||||||
| Address2: | |||||||||
| City: | CAYCE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 290334342 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8037965192 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2022 | ||||||||
| LastUpdateDate: | 06/20/2022 | ||||||||
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| AuthorizedOfficialLastName: | HOCKENBURY | ||||||||
| AuthorizedOfficialFirstName: | DEBORA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CONTRACTS MGR | ||||||||
| AuthorizedOfficialTelephone: | 2156426600 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 06/20/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA0600X | Y | Ambulatory Health Care Facilities | Clinic/Center | Adult Day Care |
No ID Information.