Provider Demographics
NPI:1588847412
Name:ACTIVE ADULT HOME HEALTH CARE EQUIPMENT, INC.
Entity type:Organization
Organization Name:ACTIVE ADULT HOME HEALTH CARE EQUIPMENT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:VASILI
Authorized Official - Middle Name:
Authorized Official - Last Name:MERABISHVILI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-412-2603
Mailing Address - Street 1:970 E 3300 S
Mailing Address - Street 2:8
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-2183
Mailing Address - Country:US
Mailing Address - Phone:801-412-2603
Mailing Address - Fax:801-413-2603
Practice Address - Street 1:970 E 3300 S
Practice Address - Street 2:8
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-2183
Practice Address - Country:US
Practice Address - Phone:801-412-2603
Practice Address - Fax:801-413-2603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-13
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT51492332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT51492OtherBUSENESS LICENSE