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General NPI Number Information
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NPI Number | 1891043527
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Entity Type | Organization
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Legal Business Name | ACTIVA HOMECARE, LLC
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Dates
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Enumeration Date | 08/28/2012
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Last Update Date | 01/10/2017
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Provider Practice Location Address
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Address Line | 5850 CORAL RIDGE DR 105
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City | CORAL SPRINGS
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State | FL
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Zip | 33076-3378
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Country | US
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Telephone | 954-344-1761
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Fax | 954-688-2958
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Provider Business Mailing Address
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Address Line | 1501 CORPORATE DR SUITE 270
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City | BOYNTON BEACH
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State | FL
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Zip | 33426-6600
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Country | US
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Telephone | 954-907-1800
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Fax | 561-207-7781
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Authorized Official
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Title or Position | CEO
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Name | MR. JONATHAN FEDELE
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Credential |
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Telephone | 561-819-0460
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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 |
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License Number State |
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