| NPI | 1134507908 |
|---|---|
| Doing Business As | ACTIVE LIFE MEDICAL |
| Entity Type | Organization |
| Authorized Contact | JEFFREY SOUZA President 318-442-2200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment (Licence: LA DME000481) |
| 332BN1400X Durable Medical Equipment & Medical Supplies, Nursing Facility Supplies (Licence: LA DME000481) | |
| 332BP3500X Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition (Licence: LA DME000481) | |
| 332BX2000X Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies (Licence: LA DME000481) | |
| Enumeration Date | 2015-05-13 |
| Last Update Date | 2015-05-13 |