Provider Demographics
NPI:1821799883
Name:ACTIVA HOME HEALTHCARE LLC
Entity Type:Organization
Organization Name:ACTIVA HOME HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:ROSELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:OSTENDORF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-362-7977
Mailing Address - Street 1:PO BOX 11099
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87192-0099
Mailing Address - Country:US
Mailing Address - Phone:505-362-7977
Mailing Address - Fax:
Practice Address - Street 1:2900 LOUISIANA BLVD NE STE B1
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-3564
Practice Address - Country:US
Practice Address - Phone:505-362-7977
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-15
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty