Provider Demographics
NPI:1124413620
Name:ATIVA LLC
Entity type:Organization
Organization Name:ATIVA LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:PAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-225-2188
Mailing Address - Street 1:18022 COWAN STE 215
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-6849
Mailing Address - Country:US
Mailing Address - Phone:949-225-2188
Mailing Address - Fax:949-225-2187
Practice Address - Street 1:18022 COWAN STE 215
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92614-6849
Practice Address - Country:US
Practice Address - Phone:949-225-2188
Practice Address - Fax:949-225-2187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-01
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIN PROCESS251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health