PRO ACTIVE ADVANTAGE, LLC


Address: 2223 Overland Ave, Burley, ID 83318-2929
Phone: 2088783423

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).

Provider Overview

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

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 103TR0400X Psychologist
Specialization: Rehabilitation
Behavioral Health & Social Service Providers

Other Provider Identifier

State Issuer Identifier Type Code
ID 8073698 05

Other Provider/Organization Names

Other Name Type Code
Pro Active Behavioral Health Doing Business As Name - Organization

Other Provider IDs and Locations

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

Other Data Sources

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

Office Location

Street Address 2223 OVERLAND AVE
City BURLEY
State ID
Zip Code 83318-2929

Providers in the same location

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

Providers in the same zip code

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
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Taxonomy Information

Taxonomy Code 103TR0400X
Grouping Behavioral Health & Social Service Providers
Classification Psychologist
Specialization Rehabilitation

Taxonomy Definition

Definition to come...

Providers in the same taxonomy and state

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
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Competitor

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City BURLEY
Zip Code 83318

Improve Information

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Dataset Information

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.

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