ACTIVE LIFE, INC. (NPI# 1073162244) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1073162244 |
| Entity Type | Organization |
| Organization Name | ACTIVE LIFE, INC. |
| Practice Address |
3300 E South St Ste 305 Lakewood CA 90805-4595 |
| Mailing Address |
1577 E Chevy Chase Dr Ste 210 Glendale CA 91206-4741 |
| Practice Telephone | 5623049866 |
| Practice Fax Number | 5623049845 |
| Mailing Telephone | 8184954610 |
| Mailing Fax Number | 8184842812 |
| Enumeration Date | 2019-09-10 |
| Last Update Date | 2019-09-10 |
| Authorized Official Name | SPENCER ARDEN DOTY (PRESIDENT) |
| Authorized Official Telephone | 8185228781 |
| Authorized Official Credential | CPO |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 335E00000X | Prosthetic/Orthotic Supplier | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | XC0009601 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154986750 | Active Life, Inc. | Prosthetic/Orthotic Supplier | 3407 W 6th St Ste 815, Los Angeles, CA 90020-2555 | 2019-05-08 |
| 1609342914 | Active Life, Inc. | Prosthetic/Orthotic Supplier | 1980 Orange Tree Ln Ste 230, Redlands, CA 92374-4559 | 2018-10-15 |
| 1063902708 | Active Life, Inc. | Prosthetic/Orthotic Supplier | 1710 Plum Ln Ste C, Redlands, CA 92374-0100 | 2018-05-17 |
| 1568961977 | Active Life, Inc. | Prosthetic/Orthotic Supplier | 855 N Lark Ellen Ave Ste A, West Covina, CA 91791-1099 | 2018-02-12 |
| 1669988176 | Active Life, Inc. | Prosthetic/Orthotic Supplier | 29645 Rancho California Rd Ste 213, Temecula, CA 92591-5285 | 2017-12-19 |
| 1497264733 | Active Life, Inc. | Prosthetic/Orthotic Supplier | 23141 Moulton Pkwy Ste 109, Laguna Hills, CA 92653-1241 | 2017-09-28 |
| 1952765711 | Active Life, Inc. | Prosthetic/Orthotic Supplier | 1700 E Cesar E Chavez Ave Ste 3750, Los Angeles, CA 90033 | 2016-04-07 |
| 1952609661 | Active Life, Inc. | Prosthetic/Orthotic Supplier | 7910 Frost St Ste 320, San Diego, CA 92123 | 2011-03-03 |
| 1942865605 | Active Life, Inc. | Prosthetic/Orthotic Supplier | 16008 Kamana Rd, Apple Valley, CA 92307-1376 | 2019-05-07 |
| 1619475894 | Active Life, Inc. | Prosthetic/Orthotic Supplier | 20911 Earl St Ste 290, Torrance, CA 90503-4354 | 2018-01-23 |
| Street Address |
3300 E SOUTH ST STE 305 |
| City | LAKEWOOD |
| State | CA |
| Zip Code | 90805-4595 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679095350 | Jean Rhadenie Hernandez Montes | Family Medicine | 3300 E South St Ste 305, Lakewood, CA 90805-4595 | 2017-07-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073154928 | Makando Mutanda | Counselor | 161 West Victoria St., Long Beach, CA 90805 | 2019-10-02 |
| 1326609496 | Alliance Hospitalist Medical Corporation | Internal Medicine | 3300 E South St Ste 307, Lakewood, CA 90805 | 2019-06-27 |
| 1609345925 | Belmont Rx LLC | Pharmacy | 6583 Atlantic Ave., 1st Floor Ste 109, Long Beach, CA 90805 | 2018-11-15 |
| 1508359605 | Mykayla Rowley | Case Manager/Care Coordinator | 5190 Atlatic Ave, Long Beach, CA 90805 | 2018-06-13 |
| 1942728589 | Marissa Liana Cabral | Social Worker | 5190 Atantic Ave, Long Beach, CA 90805 | 2017-09-04 |
| 1245757673 | Karina Vasquez | Licensed Vocational Nurse | 1325 E Poppy St, Long Beach, CA 90805 | 2017-08-25 |
| 1376060277 | Rebekkah Dawn Williams | Counselor | 100 East Market Street, Long Beach, CA 90805 | 2017-08-23 |
| 1871038919 | Andrea Dabbs | Pharmacist | 3700 E. South St., Lakewood, CA 90805 | 2016-12-28 |
| 1164972360 | Young Men's Christian Association of Greater Long Beach | Health Educator | 4949 Atlantic Ave, Long Beach, CA 90805 | 2016-10-12 |
| 1043662158 | Kristina Eunjeong Chang | Podiatrist | 3700 E South Street, Lakewood, CA 90805 | 2016-07-13 |
| Find all providers in zip 90805 | ||||
| Taxonomy Code | 335E00000X |
| Grouping | Suppliers |
| Classification | Prosthetic/Orthotic Supplier |
| An organization that provides prosthetic and orthotic care which may include, but is not limited to, patient evaluation, prosthesis or orthosis design, fabrication, fitting and modification to treat limb loss for purposes of restoring physiological function and/or cosmesis or to treat a neuromusculoskeletal disorder or acquired condition. |
| Notes: Source: American Board for Certification in Orthotics, Prosthetics, and Pedorthics, Inc. [7/1/2010: modified, 7/1/2013: modified] Additional Resources: American Board for Certification in Orthotics, Prosthetics and Pedorthics, Inc., www.abcop.org and Board of Certification/Accreditation, International, www.bocusa.org. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811457088 | Evening Elegance LLC | Prosthetic/Orthotic Supplier | 14500 W Colfax Ave Unit 246, Lakewood, CO 80401 | 2019-03-22 |
| 1760968796 | Fountain Valley Orthotics and Prosthetics, Inc. | Prosthetic/Orthotic Supplier | 3650 South St Ste 110b, Lakewood, CA 90712-1502 | 2018-07-12 |
| 1780915744 | Los Angeles Orthopedic Group Inc | Prosthetic/Orthotic Supplier | 5257 Paramount Blvd, Lakewood, CA 90712-2121 | 2010-01-14 |
| 1861720898 | Gina's Salon & Wigs | Prosthetic/Orthotic Supplier | 17303 Detroit Ave, Lakewood, OH 44107-3426 | 2009-12-02 |
| 1720144330 | Associated Prosthetics and Orthotics | Prosthetic/Orthotic Supplier | 5241 Paramount Blvd, Lakewood, CA 90712-2121 | 2006-12-28 |
| 1386647543 | Colorado Professional Medical, Inc | Prosthetic/Orthotic Supplier | 11750 W 2nd Pl, St. Anthony Medical Plaza, Lakewood, CO 80228-1575 | 2005-05-23 |
| 1093352965 | Evening Elegance LLC | Prosthetic/Orthotic Supplier | 14500 W Colfax Ave Unit 246, Lakewood, CO 80401-3227 | 2019-12-10 |
| 1164927000 | Comfort Medical Supply Inc | Prosthetic/Orthotic Supplier | 1000 Route 70 Ste 9, Lakewood, NJ 08701-5961 | 2018-03-23 |
| 1063780377 | Lizotte P&o Associates LLC | Prosthetic/Orthotic Supplier | 5605 100th St Sw, Suite A, Lakewood, WA 98499-2710 | 2011-12-01 |
| 1235392507 | Curative Medical Services | Prosthetic/Orthotic Supplier | 26 Pine Blvd, Lakewood, NJ 08701-5284 | 2008-07-08 |
| Find all providers in LAKEWOOD | ||||
Please comment or provide details below to improve the information on ACTIVE LIFE, INC..
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.