NPIMap

Organization Active NPI

Activus, LLC

Doing business as Active Home Health

  • Home Health Agency
  • Sandy, UT
National Provider Identifier
1013482819
Registry record updated Jan 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
ACTIVUS, LLC
Doing business as
Active Home Health
Practice address
8180 S 700 E Ste 100
Sandy, UT 84070-0567
Phone
(801) 438-6285
Fax
(801) 438-6286
NPI assigned
Oct 8, 2018
Last updated
Jan 13, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 13, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Michael Nielson, MBA
Title
Administrator/Member
Phone
(801) 842-9987

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X Primary

Addresses

Primary practice location

8180 S 700 E Ste 100
Sandy, UT 84070-0567

Mailing address

8180 S 700 E Ste 100
Sandy, UT 84070-0567
Phone (801) 438-6285

Other names 1

  • Active Home Health Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20181127000904 UT Part A Provider - Home Health Agency 0941554232 Practice locations: Sandy, UT

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1013482819. Details of each certification follow.

Home health agency certification: CCN 467321

Legal name
ACTIVUS LLC
Doing business as
ACTIVE HOME HEALTH
Certification status
Active
Provider type (POS)
Home health agency
Participating since
May 25, 2011
Last certification
Aug 7, 2019
Ownership / control type
Proprietary
Organization structure
LLCProprietary
Incorporated
Mar 30, 2018 in UT
Enrollment address
8180 S 700 E
Ste 100
Sandy, UT 84070-0567

Care Compare: Home health agency

Medicare Care Compare
Listed as
Active Home HealthCCN 467321 · All quality measures
Overall star rating
5 of 5
Ownership
Proprietary
Certified
May 25, 2011
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

National Provider Directory

National Provider Directory

Locations

9138 S State St
Ste 102
Sandy, UT 84070
Phone (801) 438-6285

Ownership & related parties

All disclosed owners & managing parties 4

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Nicole Hoyt Individual 5% Or Greater Direct Ownership InterestCo-Owner Sep 28, 2018 16.67%
Angelic Arana Individual 5% Or Greater Direct Ownership InterestDirector of Clinical Services Jan 1, 2020 10%
Operational/Managerial ControlDirector of Clinical Services Jan 1, 2020 10%
Colby K Haderlie Individual 5% Or Greater Direct Ownership InterestDirector of Marketing Jan 1, 2020 36.66%
W-2 Managing EmployeeDirector of Marketing Sep 28, 2018
Operational/Managerial ControlDirector of Marketing Jan 1, 2020 36.66%
Michael M Nielson Individual 5% Or Greater Direct Ownership InterestAdministrator Jan 1, 2020 36.67%
Corporate OfficerPresident Sep 28, 2018
W-2 Managing EmployeeAdministrator Sep 28, 2018
Operational/Managerial ControlAdministrator Jan 1, 2020 36.67%

Change-of-ownership history 1

DateEventCounterparty
Sep 28, 2018 Change of OwnershipThis provider was the buyer Active Home HealthCCN 467321, UT, NPI 1316379373

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

Practitioners & affiliated clinicians

Affiliated clinicians 15

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 15

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1538956800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1673568000000",
    "number": "1013482819",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8180 S 700 E STE 100",
            "city": "SANDY",
            "state": "UT",
            "postal_code": "840700567",
            "telephone_number": "801-438-6285",
            "fax_number": "801-438-6286"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8180 S 700 E STE 100",
            "city": "SANDY",
            "state": "UT",
            "postal_code": "840700567",
            "telephone_number": "801-438-6285",
            "fax_number": "801-438-6286"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACTIVUS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-10-08",
        "last_updated": "2023-01-13",
        "certification_date": "2023-01-13",
        "status": "A",
        "authorized_official_last_name": "NIELSON",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "ADMINISTRATOR/MEMBER",
        "authorized_official_telephone_number": "801-842-9987",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MBA"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Active Home Health",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Active Home Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sandy, UT

Sources for this page

Verify at the official NPI Registry.