Ativa LLC

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

License

IN PROCESS Issued in CA

Legal business name

ATIVA LLC

Practice address

18022 Cowan Ste 215
Irvine, CA 92614-6849

Phone

(949) 225-2188

Fax

(949) 225-2187

NPI assigned

Apr 1, 2015

Organization subpart

No

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

Authorized official

Name

Marvin Pan

Title

VP Operations

Phone

(949) 225-2188

Specialties & licenses 1

Addresses

Other names 1

• Ativa Home Health Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Home health agency certification: CCN 059781

Legal name

ATIVA LLC

Doing business as

ATIVA HOME HEALTH

Certification status

Active

Provider type (POS)

Home health agency

Participating since

Jan 11, 2017

Last certification

Dec 6, 2019

Ownership / control type

Proprietary

Organization structure

LLCProprietary

Incorporated

Jul 9, 2014 in CA

Enrollment address

18022 Cowan
Ste 215
Irvine, CA 92614-6849
HHA Branch

Listed as

Ativa Home HealthCCN 059781

Ownership

Proprietary

Certified

Jan 11, 2017

Medicare certification status

ActiveFrom the Provider of Services file

Services

Nursing, Physical therapy, Speech pathology, Occupational therapy

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

All disclosed owners & managing parties 2

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

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

{
    "created_epoch": "1427846400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1536710400000",
    "number": "1124413620",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18022 COWAN STE 215",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926146849",
            "telephone_number": "949-225-2188",
            "fax_number": "949-225-2187"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18022 COWAN STE 215",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926146849",
            "telephone_number": "949-225-2188",
            "fax_number": "949-225-2187"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ATIVA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-01",
        "last_updated": "2018-09-12",
        "status": "A",
        "authorized_official_last_name": "PAN",
        "authorized_official_first_name": "MARVIN",
        "authorized_official_title_or_position": "VP OPERATIONS",
        "authorized_official_telephone_number": "949-225-2188"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "CA",
            "license": "IN PROCESS",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ativa Home Health",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Ativa Home Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Home Health Agency in Irvine, CA
• Providers in Irvine, CA by specialty
• Home Health Agency in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.