Provider Demographics
NPI:1013482819
Name:ACTIVUS, LLC
Entity Type:Organization
Organization Name:ACTIVUS, LLC
Other - Org Name:ACTIVE HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR/MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:NIELSON
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:801-842-9987
Mailing Address - Street 1:8180 S 700 E STE 100
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-0567
Mailing Address - Country:US
Mailing Address - Phone:801-438-6285
Mailing Address - Fax:801-438-6286
Practice Address - Street 1:8180 S 700 E STE 100
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-0567
Practice Address - Country:US
Practice Address - Phone:801-438-6285
Practice Address - Fax:801-438-6286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-08
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health