Basic Information
| Provider Information | |||||||||
| NPI: | 1891443685 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ACTIVE SC ONE, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6 INTERPLEX DR STE 401 | ||||||||
| Address2: | |||||||||
| City: | TREVOSE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190536942 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2156426600 | ||||||||
| FaxNumber: | 2158275950 | ||||||||
| Practice Location | |||||||||
| Address1: | 2111 W JODY RD | ||||||||
| Address2: | |||||||||
| City: | FLORENCE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295012031 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8436290103 | ||||||||
| FaxNumber: | 8436640184 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/11/2022 | ||||||||
| LastUpdateDate: | 03/11/2022 | ||||||||
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| AuthorizedOfficialLastName: | HOCKENBURY | ||||||||
| AuthorizedOfficialFirstName: | DEBORA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CONTRACTS & REGULATORY MGR | ||||||||
| AuthorizedOfficialTelephone: | 2156426600 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ACTIVE DAY INC | ||||||||
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| NPICertificationDate: | 02/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA0600X | Y | Ambulatory Health Care Facilities | Clinic/Center | Adult Day Care |
No ID Information.