Healthcare Provider Details

I. General information

NPI: 1518695451
Provider Name (Legal Business Name): AVIVA HOME HEALTH CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2022
Last Update Date: 08/09/2022
Certification Date: 08/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3175 S CONGRESS AVE
PALM SPRINGS FL
33461-2500
US

IV. Provider business mailing address

1122 PRIMROSE LN
WELLINGTON FL
33414-8694
US

V. Phone/Fax

Practice location:
  • Phone: 561-891-6496
  • Fax:
Mailing address:
  • Phone: 561-891-6496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: YVENA JUSTABE
Title or Position: OWNER/ALT ADMINISTRATOR
Credential:
Phone: 561-891-6496