PRO ACTIVE ADVANTAGE, LLC (NPI# 1124148176) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1124148176 |
Entity Type | Organization |
Organization Name | PRO ACTIVE ADVANTAGE, LLC |
Other Organization Name | PRO ACTIVE BEHAVIORAL HEALTH |
Practice Address |
2223 Overland Ave Burley ID 83318-2929 |
Mailing Address |
215 University Dr Gooding ID 83330-6155 |
Practice Telephone | 2088783423 |
Practice Fax Number | 2088783424 |
Mailing Telephone | 2089345880 |
Mailing Fax Number | 2089345876 |
Enumeration Date | 2007-03-30 |
Last Update Date | 2015-02-16 |
Authorized Official Name | FRANK J KNIGHT (CEO) |
Authorized Official Telephone | 2089345880 |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 103TR0400X |
Psychologist Specialization: Rehabilitation |
Behavioral Health & Social Service Providers |
State | Issuer | Identifier | Type Code |
---|---|---|---|
ID | 8073698 | 05 |
Other Name | Type Code |
---|---|
Pro Active Behavioral Health | Doing Business As Name - Organization |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1427170133 | Pro Active Advantage, LLC | Psychologist | 264 Main Ave S, Twin Falls, ID 83301-6232 | 2007-04-04 |
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 |
1225139298 | Pro Active Advantage, LLC | Counselor | 562 Shoup Ave W, Twin Falls, ID 83301-5029 | 2006-09-25 |
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 |
2223 OVERLAND AVE |
City | BURLEY |
State | ID |
Zip Code | 83318-2929 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1023513777 | Nohemi Vasquez | Counselor | 2223 Overland Ave, Burley, ID 83318-2929 | 2018-03-26 |
1073634713 | Pro Active Advantage, LLC | Counselor | 2223 Overland Ave, Burley, ID 83318-2929 | 2007-04-02 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1902366834 | Pain & Spine Consultants | Clinic/Center | 1344 Hiland Avenue, Ste A, Burley, ID 83318 | 2019-03-25 |
1609335090 | Hurst Medical Pllc | Clinic/Center | 1700 Overland Ave Ste 1, Burley, ID 83318 | 2019-03-15 |
1831654243 | Mini-cassia Hearts 4 Seniors | In Home Supportive Care | 135 East 23rd Drive, Burley, ID 83318 | 2019-02-11 |
1841760493 | Burley Family Dental Pllc | Dentist | 2200 Parke Ave Ste 2, Burley, ID 83318 | 2018-11-27 |
1831634823 | Skye Fahnlander | Occupational Therapy Assistant | 2303 Parke Ave, Burley, ID 83318 | 2016-12-29 |
1285024497 | Albion Valley Health Clinic Inc. | Clinic/Center | 400 West 5th Street, Burley, ID 83318 | 2015-01-26 |
1124372370 | A Plus Solutions Center | Clinic/Center | 2311 Parke Ave. Unit 3, Suite 12, Burley, ID 83318 | 2012-11-08 |
1831442805 | A Plus Solutions Developmental Center LLC | Day Training, Developmentally Disabled Services | 2251 Overland Avenue, Suite Number 5, Burley, ID 83318 | 2012-10-16 |
1619258159 | Keleah Margrete Goldammer | Occupational Therapist | 2303 Parke Avenue, Burley, ID 83318 | 2011-08-29 |
1932490984 | Tamera Chatburn | Counselor | 531 East 5th St., Preferred Child and Family Services, Burley, ID 83318 | 2011-04-26 |
Find all providers in zip 83318 |
Taxonomy Code | 103TR0400X |
Grouping | Behavioral Health & Social Service Providers |
Classification | Psychologist |
Specialization | Rehabilitation |
Definition to come... |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1376160820 | Mind Matters LLC | Psychologist | 8382 N Wayne Dr Ste 103b, Hayden, ID 83835-6028 | 2020-07-01 |
1003392598 | Joshua Welz | Psychologist | 3211 N Guinness Ln Apt 201, Post Falls, ID 83854 | 2018-07-17 |
1780061507 | Frank Howe | Psychologist | 167 North 4th East, Downey, ID 83234-0282 | 2015-04-30 |
1124454509 | Carlos Williams | Psychologist | 4696 W Overland Rd Ste 252, Boise, ID 83705-2877 | 2013-09-18 |
1528400793 | Marilyn Standfield | Psychologist | 1202 E 25th St, Idaho Falls, ID 83404-7072 | 2013-07-29 |
1467702829 | Rick N. Ho Chee | Psychologist | 2466 Addison Ave. East, Twin Falls, ID 83301 | 2012-09-13 |
1932454642 | Adolpho Enterprise LLC. | Psychologist | 2847 Hidden Hutch, Ammon, ID 83401-6036 | 2012-07-18 |
1174833966 | Kimberly Sue Kelly | Psychologist | 630 S Woodruff Ave, Idaho Falls, ID 83401-5299 | 2010-10-14 |
1821207580 | Firm Fouindations LLC | Psychologist | 2496 Mesa St, Idaho Falls, ID 83401-3369 | 2007-05-21 |
1427170133 | Pro Active Advantage, LLC | Psychologist | 264 Main Ave S, Twin Falls, ID 83301-6232 | 2007-04-04 |
Find all providers with the same taxonomy |
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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.