Provider Demographics
NPI:1902194889
Name:ACTIVSTYLE, LLC
Entity Type:Organization
Organization Name:ACTIVSTYLE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIGGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-206-0040
Mailing Address - Street 1:220 W GERMANTOWN PIKE STE 250
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH MEETING
Mailing Address - State:PA
Mailing Address - Zip Code:19462-1437
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2615 E END BLVD S
Practice Address - Street 2:SUITE 235
Practice Address - City:MARSHALL
Practice Address - State:TX
Practice Address - Zip Code:75672-7425
Practice Address - Country:US
Practice Address - Phone:903-923-7010
Practice Address - Fax:903-923-7011
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADAPTHEALTH LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-07-13
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1409928Medicaid
AR203671716Medicaid
TX286522201 & 02Medicaid
AR203671716Medicaid