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General NPI Number Information
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NPI Number | 1376549675
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Entity Type | Organization
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Legal Business Name | ACTIVA HEALTH SERVICES, INC.
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Dates
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Enumeration Date | 06/22/2005
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Last Update Date | 06/20/2024
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Provider Practice Location Address
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Address Line | 7451 WILES RD STE 207
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City | CORAL SPRINGS
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State | FL
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Zip | 33067-2040
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Country | US
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Telephone | 954-900-1110
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Fax | 954-382-0377
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Provider Business Mailing Address
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Address Line | 1165 NORTHCHASE PKWY SE STE 250
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City | MARIETTA
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State | GA
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Zip | 30067-6432
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Country | US
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Telephone | 470-421-0191
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Fax | 561-207-7843
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Authorized Official
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Title or Position | SVP OF COMPLIANCE
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Name | MARCELLA LYNCH
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Credential |
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Telephone | 470-392-9412
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | HHA299991980
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | HHA299991942
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License Number State | FL
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