MEDICARE: ACTIVA HEALTH SERVICES, 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	251E00000X	Home Health Agency		FL

General Provider Information

NPI Number	:	1770559718
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACTIVA HEALTH SERVICES, INC.

Provider Business Mailing Address
First Line	:	1165 NORTHCHASE PKWY SE STE 250
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30067-6432
Country	:	US
Telephone Number	:	470-421-0191
Fax Number	:	561-207-7843

Provider Business Practice Location Address
First Line	:	729 SW FEDERAL HWY STE 222
Second Line	:
City	:	STUART
State	:	FL
Zip	:	34994-2913
Country	:	US
Telephone Number	:	772-249-0606
Fax Number	:	877-241-1761

Authorized Official
Title or Position	:	SVP OF COMPLIANCE
Name	:	MARCELLA LYNCH
Credential	:
Telephone Number	:	470-392-9412

Provider Enumeration Date	:	02/28/2006
Last Update Date	:	06/20/2024

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