Provider Demographics
NPI:1588489694
Name:ACTIVE CARE HATFIELD
Entity type:Organization
Organization Name:ACTIVE CARE HATFIELD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MAYA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-595-3946
Mailing Address - Street 1:414 RANDALL RD
Mailing Address - Street 2:
Mailing Address - City:WYNCOTE
Mailing Address - State:PA
Mailing Address - Zip Code:19095-2106
Mailing Address - Country:US
Mailing Address - Phone:215-595-3946
Mailing Address - Fax:215-827-5606
Practice Address - Street 1:39 MARKET ST
Practice Address - Street 2:
Practice Address - City:HATFIELD
Practice Address - State:PA
Practice Address - Zip Code:19440-2553
Practice Address - Country:US
Practice Address - Phone:215-362-5949
Practice Address - Fax:215-827-5606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-22
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty