ACTIVE LIFE, LLC; NPI #1568961977

Contact Information

ACTIVE LIFE, LLC

1135 S SUNSET AVE STE 302
WEST COVINA, CA 91790-3964

Phone: 626-727-6455
Fax: 626-360-3220
Website:

	Specialty	Taxonomy Code	Specialty Code	Provider Type
	Prosthetic/Orthotic Supplier	335E00000X	51	Medical Supply Company with Orthotist

Indicates primary specialty

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NPI Profile & details for ACTIVE LIFE, LLC

NPI # 1568961977

LBN Legal business name ACTIVE LIFE, LLC

Authorized official PALLAVI NEMANI - (COMPLIANCE OFFICER)

Entity Organization

Organization subpart ¹ No

Enumeration date 02/12/2018

Last updated 01/24/2023 - About 3 years ago

Identifiers

Medicaid

XC0009601

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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