Provider Demographics
NPI:1376549675
Name:ACTIVA HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:ACTIVA HEALTH SERVICES, INC.
Other - Org Name:NIGHTINGALE PRIVATE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANNE MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-819-0460
Mailing Address - Street 1:1501 CORPORATE DR STE 260
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-6661
Mailing Address - Country:US
Mailing Address - Phone:561-819-0460
Mailing Address - Fax:561-207-7843
Practice Address - Street 1:12350 NW 39TH ST # 203
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-2418
Practice Address - Country:US
Practice Address - Phone:954-382-0300
Practice Address - Fax:954-382-0377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-22
Last Update Date:2019-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHHA299991980251E00000X
FLHHA299991942251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL108086Medicare Oscar/Certification