Activus, LLC
Organization Active NPI Home Health Agency · Sandy, UT
NPI 1013482819 · NPPES record last updated Jan 13, 2023
Key facts
- NPI
- 1013482819
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Home Health Agency 251E00000X
- Legal business name
- ACTIVUS, LLC
- 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
- Organization subpart
- No
Authorized official
- Name
- Mr. Michael Nielson, MBA
- Title
- Administrator/Member
- Phone
- (801) 842-9987
Change of ownership 1
Affiliated clinicians 15
-
Shannon L Compton, FNP
-
Lacey A Cooper, NP-C
-
David Earl Curtis, M.D.
-
Amy Flynn, APRN
-
David Kuo, M.D.
-
Stephen L Miller, MD
-
Nathan G Momberger, M.D.
-
Danesh Rahimi, MD
-
Sonia Sarfraz, MD
-
Mehrnoosh Shakeri, MD, MPH
-
Terry Russell Van Wormer, PA-C
-
Cassidy Warren, APRN
-
Rebecca H Reiser, M.D.
Medicare Care Compare: Home health agency
- Listed as
- Active Home Health
- Overall star rating
- ★★★★★ 5 of 5
- Ownership
- Proprietary
- Certified
- May 25, 2011
- Medicare certification status
- Active
- Services
- Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in UT
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
- LLC · Proprietary
- Incorporated
- Mar 30, 2018 in UT
- Enrollment address
- 8180 S 700 E
Ste 100
Sandy, UT 84070-0567
All disclosed owners & managing parties 4
| Name | Role | Since | Share |
|---|---|---|---|
| Nicole Hoyt |
5% Or Greater Direct Ownership Interest |
Sep 28, 2018 | 16.67% |
| Angelic Arana |
5% Or Greater Direct Ownership Interest |
Jan 1, 2020 | 10% |
| Operational/Managerial Control |
Jan 1, 2020 | 10% | |
| Colby K Haderlie |
5% Or Greater Direct Ownership Interest |
Jan 1, 2020 | 36.66% |
| W-2 Managing Employee |
Sep 28, 2018 | ||
| Operational/Managerial Control |
Jan 1, 2020 | 36.66% | |
| Michael M Nielson |
5% Or Greater Direct Ownership Interest |
Jan 1, 2020 | 36.67% |
| Corporate Officer |
Sep 28, 2018 | ||
| W-2 Managing Employee |
Sep 28, 2018 | ||
| Operational/Managerial Control |
Jan 1, 2020 | 36.67% |
Change-of-ownership history
| Date | Event | Counterparty |
|---|---|---|
| Sep 28, 2018 | Change of Ownership |
Active Home Health |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20181127000904 | UT | Part a Provider - Home Health Agency | 0941554232 | Practice locations: Sandy, UT |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Agency | 251E00000X | Yes |
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
- Active Home Health
Other providers in Sandy, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 13, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.