MEDICARE: AVIVA AT HOME INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1386138543
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AVIVA AT HOME INC

Provider Business Mailing Address
First Line	:	1380 NE MIAMI GARDENS DR STE 235
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33179-4750
Country	:	US
Telephone Number	:	305-403-2622
Fax Number	:	866-241-0043

Provider Business Practice Location Address
First Line	:	499 E PALMETTO PARK RD STE 227
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33432-5092
Country	:	US
Telephone Number	:	305-403-2622
Fax Number	:	866-241-0043

Authorized Official
Title or Position	:	PRESIDENT
Name	:	TERRY ANN ADLER
Credential	:
Telephone Number	:	305-403-2622

Provider Enumeration Date	:	06/20/2018
Last Update Date	:	06/20/2018

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