Provider Demographics
NPI:1962372219
Name:ACTIVEHEAL WOUND CARE
Entity type:Organization
Organization Name:ACTIVEHEAL WOUND CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ARTAK
Authorized Official - Middle Name:
Authorized Official - Last Name:MKHITARYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:747-400-1014
Mailing Address - Street 1:121 W LEXINGTON DR STE 418A
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-3663
Mailing Address - Country:US
Mailing Address - Phone:747-400-1014
Mailing Address - Fax:747-400-1015
Practice Address - Street 1:121 W LEXINGTON DR STE 418A
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-3663
Practice Address - Country:US
Practice Address - Phone:747-400-1014
Practice Address - Fax:747-400-1015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-11-10
Last Update Date:2025-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center