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Contact Information

PRO ACTIVE ADVANTAGE, LLC
1369 E 16TH ST STE 2
BURLEY, ID83318-2008
 Phone: 208-878-3423
 Fax: 208-878-3424
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Rehabilitation

103TR0400X 62 Psychologist, Clinical
Indicates primary specialty

NPI Profile & details for PRO ACTIVE ADVANTAGE, LLC

NPI # 1124148176
LBN Legal business name PRO ACTIVE ADVANTAGE, LLC
Authorized official FRANK KNIGHT - (CEO)
Entity Organization
Organization subpart 1 No
Enumeration date 03/30/2007
Last updated 09/15/2021 - About 5 years ago
Identifiers
ID Medicaid 8073698
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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