Provider Demographics
NPI:1003249285
Name:PROACTIVE HOME CARE, INC.
Entity type:Organization
Organization Name:PROACTIVE HOME CARE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:REGULATORY
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MULLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-734-1420
Mailing Address - Street 1:2930 SW WANAMAKER DR
Mailing Address - Street 2:103
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66614-4116
Mailing Address - Country:US
Mailing Address - Phone:855-881-7442
Mailing Address - Fax:
Practice Address - Street 1:2930 SW WANAMAKER DR
Practice Address - Street 2:103
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66614-4116
Practice Address - Country:US
Practice Address - Phone:855-881-7442
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROACTIVE HOME CARE, INC. DBA PHOENIX HOME CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-08-12
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health