Provider Demographics
NPI:1649548777
Name:ACTIVA HEALTH SERVICES
Entity type:Organization
Organization Name:ACTIVA HEALTH SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SVP OF COMPLIANCE
Authorized Official - Prefix:
Authorized Official - First Name:MARCELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:LYNCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:470-392-9412
Mailing Address - Street 1:1165 NORTHCHASE PKWY SE STE 250
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-6432
Mailing Address - Country:US
Mailing Address - Phone:470-421-0191
Mailing Address - Fax:561-207-7843
Practice Address - Street 1:3055 CARDINAL DR STE 301
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32963-4925
Practice Address - Country:US
Practice Address - Phone:772-249-0606
Practice Address - Fax:772-673-6112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-04
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299993848251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health