Provider Demographics
NPI:1891043527
Name:ACTIVA HOMECARE, LLC
Entity type:Organization
Organization Name:ACTIVA HOMECARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FEDELE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-819-0460
Mailing Address - Street 1:1501 CORPORATE DR
Mailing Address - Street 2:SUITE 270
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-6600
Mailing Address - Country:US
Mailing Address - Phone:954-907-1800
Mailing Address - Fax:561-207-7781
Practice Address - Street 1:5850 CORAL RIDGE DR
Practice Address - Street 2:105
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33076-3378
Practice Address - Country:US
Practice Address - Phone:954-344-1761
Practice Address - Fax:954-688-2958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-28
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health