PRO ACTIVE ADVANTAGE, LLC (NPI# 1225139298) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1225139298 |
| Entity Type | Organization |
| Organization Name | PRO ACTIVE ADVANTAGE, LLC |
| Other Organization Name | PRO ACTIVE BEHAVIORAL HEALTH |
| Practice Address |
562 Shoup Ave W Twin Falls ID 83301-5029 |
| Practice Telephone | 2087340407 |
| Practice Fax Number | 2087343534 |
| Mailing Telephone | 2087340407 |
| Mailing Fax Number | 2087343534 |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2020-01-02 |
| Authorized Official Name | MR. FRANK J KNIGHT (CEO) |
| Authorized Official Telephone | 2089345880 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 101Y00000X | Counselor | ========= | ID | Behavioral Health & Social Service Providers |
| Y | 101YM0800X |
Counselor Specialization: Mental Health |
========= | ID | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ID | 807373500 | 05 |
| Other Name | Type Code |
|---|---|
| Pro Active Behavioral Health | Doing Business As Name - Organization |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 264 Main Ave S, Twin Falls, ID 833016232 | 2087340407 | 2087343534 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427170133 | Pro Active Advantage, LLC | Psychologist | 264 Main Ave S, Twin Falls, ID 83301-6232 | 2007-04-04 |
| 1124148176 | Pro Active Advantage, LLC | Psychologist | 2223 Overland Ave, Burley, ID 83318-2929 | 2007-03-30 |
| 1730200460 | Pro Active Advantage, LLC | Psychologist | 215 University Dr, Gooding, ID 83330-6155 | 2007-04-02 |
| 1073634713 | Pro Active Advantage, LLC | Counselor | 2223 Overland Ave, Burley, ID 83318-2929 | 2007-04-02 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | PRO ACTIVE ADVANTAGE, LLC | 562 Shoup Ave W, Twin Falls, ID 83301-5029 |
| Street Address |
562 SHOUP AVE W |
| City | TWIN FALLS |
| State | ID |
| Zip Code | 83301-5029 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659316875 | Twin Falls Orthopedics, Pllc | Specialist | 562 Shoup Ave W, Twin Falls, ID 83301-5029 | 2006-06-19 |
| 1972741882 | Stephanie A Latimer | Registered Nurse | 562 Shoup Ave W, Twin Falls, ID 83301-5029 | 2009-01-30 |
| 1053589432 | Twin Falls Orthopedics LLC | Nurse Practitioner | 562 Shoup Ave W, Twin Falls, ID 83301-5029 | 2008-02-19 |
| 1336346469 | Twin Falls Orthopedics Pllc | Nurse Practitioner | 562 Shoup Ave W, Twin Falls, ID 83301-5029 | 2007-07-02 |
| 1275685356 | Charlene Surbaugh | Registered Nurse | 562 Shoup Ave W, Twin Falls, ID 83301-5029 | 2007-01-17 |
| 1124185053 | Twin Falls Imaging & Diagnostic Center LLC | Clinic/Center | 562 Shoup Ave W, Twin Falls, ID 83301-5029 | 2007-01-02 |
| 1922168723 | Patricia Lincoln | Specialist | 562 Shoup Ave W, Twin Falls, ID 83301-5029 | 2006-12-11 |
| 1669483509 | Twin Falls Imaging and Diagnostic Center | Clinic/Center | 562 Shoup Ave W, Twin Falls, ID 83301-5029 | 2006-08-09 |
| 1255345765 | Idaho Independent Mri LLC | Clinic/Center | 562 Shoup Ave W, Twin Falls, ID 83301-5029 | 2006-07-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023645918 | Matthew Anderson | Pharmacist | Dick's Pharmacy, 526 K Shoup Ave W, Twin Falls, ID 83301 | 2020-03-23 |
| 1780146316 | Frontier Pediatric Partners, Pllc | Pediatrics | 1502 Locust Street N #700, Twin Falls, ID 83301 | 2019-04-02 |
| 1972073377 | Wood River Acupuncture | Acupuncturist | 1625 Addison Ave East, Twin Falls, ID 83301 | 2018-11-28 |
| 1235629874 | Lonnie Paul | Counselor | 1092 Eastland Dr N Ste A, Twin Falls, ID 83301 | 2018-05-17 |
| 1679060966 | Christina Jirapha Thongdee | Social Worker | 625 Poleline Road West, Suite 2a, Twin Falls, ID 83301 | 2018-04-23 |
| 1437658499 | Tyrel Kevin Ward | Chiropractor | 2167 Village Park Ave., Suite 100, Twin Falls, ID 83301 | 2018-02-06 |
| 1851836381 | Tanabell Health Services, Inc | Skilled Nursing Facility | 1134 Cheney Drive West, Twin Falls, ID 83301 | 2016-12-19 |
| 1578005195 | Matthew Carter | Physical Therapist | 1053 Eastland Drive, Twin Falls, ID 83301 | 2016-11-14 |
| 1790227783 | Murvat Usmanova | Nurse Practitioner | 775 Pole Line Road W, Suite 203, Twin Falls, ID 83301 | 2016-11-08 |
| 1265894687 | Shawna Fultz | Social Worker | 1201 Fall Ave East Suite C, Twin Falls, ID 83301 | 2016-03-24 |
| Find all providers in zip 83301 | ||||
| Taxonomy Code | 101YM0800X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316563505 | Family Health Services Corporation | Counselor | 607 2nd Ave E, Twin Falls, ID 83301-7128 | 2020-06-23 |
| 1306462593 | Family Health Services Corporation | Counselor | 452 Caswell Ave W, Twin Falls, ID 83301-3700 | 2020-06-23 |
| 1891319604 | Erin Michelle Dunning | Counselor | 459 Locust St N Ste 102, Twin Falls, ID 83301-7324 | 2020-06-08 |
| 1841855798 | Shelly Marie Osborne | Counselor | 112 Shoshone St E Ste 2, Twin Falls, ID 83301-6185 | 2019-05-07 |
| 1770072522 | Matthew Jordan Kezele | Counselor | 1363 Fillmore St Ste B, Twin Falls, ID 83301-3392 | 2018-05-08 |
| 1841713385 | Jessica Lynn Quaintance | Counselor | 1411 Falls Ave E Ste 207, Twin Falls, ID 83301-3455 | 2017-07-17 |
| 1215375266 | Michael S Bezas | Counselor | 722 Cheney Dr, Twin Falls, ID 83301-3472 | 2013-06-12 |
| 1699013482 | Janice Carson Nielsen | Counselor | 1411 Falls Ave.w, Suite 205, Twin Falls, ID 83301 | 2013-01-29 |
| 1114203031 | Chester C Mardis | Counselor | 493 Eastland Dr., Twin Falls, ID 83301 | 2011-10-24 |
| 1710295845 | Lucy Brazil-wilkes | Counselor | 834 Falls Ave Ste 1050, Twin Falls, ID 83301-3363 | 2010-09-23 |
| Find all providers in TWIN FALLS | ||||
| City | TWIN FALLS |
| Zip Code | 83301 |
Please comment or provide details below to improve the information on PRO ACTIVE ADVANTAGE, LLC.
| 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.