NPIMap

Organization Active NPI

Activa Health Services

Doing business as Activa Home Health

  • Home Health Agency
  • Vero Beach, FL
National Provider Identifier
1649548777
Registry record updated May 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
299993848 Issued in FL
Legal business name
ACTIVA HEALTH SERVICES
Doing business as
Activa Home Health
Practice address
3055 Cardinal Dr Ste 301
Vero Beach, FL 32963-4925
Phone
(772) 249-0606
Fax
(772) 673-6112
NPI assigned
Dec 4, 2011
Last updated
May 20, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 20, 2024

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

Authorized official

Name
Marcella Lynch
Title
SVP of Compliance
Phone
(470) 392-9412

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X 299993848 FL Primary

Addresses

Primary practice location

3055 Cardinal Dr Ste 301
Vero Beach, FL 32963-4925

Mailing address

1165 Northchase Pkwy SE Ste 250
Marietta, GA 30067-6432
Phone (470) 421-0191

Other names 1

  • Activa Home Health Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040813001039 FL Part A Provider - Home Health Agency 9830188606 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Stuart, FL; Vero Beach, FL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1649548777. Details of each certification follow.

Home health agency certification: CCN 108113

Legal name
ACTIVA HEALTH SERVICES, INC.
Doing business as
ACTIVA HOME HEALTH
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Nov 16, 2004
Last certification
Oct 20, 2015
Ownership / control type
Proprietary
Organization structure
CorporationProprietary
Incorporated
Feb 5, 2004 in FL
Enrollment address
729 SW Federal Hwy
Ste 222
Stuart, FL 34994-2913

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Home health agency

Medicare Care Compare
Listed as
Activa Home HealthCCN 108113 · All quality measures
Overall star rating
4 of 5
Ownership
Proprietary
Certified
Nov 16, 2004
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D2020716Activa Home Health3055 Cardinal Dr Ste 301, Vero Beach, FL 32963Certificate of waiverFeb 24, 2027

National Provider Directory

National Provider Directory
Tax ID family
Activa Health Services2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1856 SE Port St Lucie Blvd
Port St Lucie, FL 34952
Phone (772) 237-3530

3201 Cardinal Dr
Vero Beach, FL 32963

Ownership & related parties

All disclosed owners & managing parties 6

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

NameRoleSinceShare
Marcella Lynch Individual W-2 Managing EmployeeCompliance Officer Feb 10, 2021
Operational/Managerial ControlPresident of Home Health Jul 1, 2024
88-HC Acquisition Holding L.P. Organization, Greenwich, CT 5% Or Greater Direct Ownership Interest Oct 30, 2018 100%
David Jones Individual Corporate OfficerCeo Jul 1, 2024
Tara Matthews Individual Corporate OfficerCfo Jul 1, 2024
Accord Dolphin Acquistion Corp Organization, Marietta, GA Created for acquisition, Corporation Limited Partnership Interest Sep 17, 2021 99%
Accordcare LLC Organization, Marietta, GA LLC General Partnership Interest Sep 17, 2021

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Affiliated clinicians 62

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

View all 62

NPI Registry JSON

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

{
    "created_epoch": "1322956800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1716163200000",
    "number": "1649548777",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1165 NORTHCHASE PKWY SE STE 250",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300676432",
            "telephone_number": "470-421-0191",
            "fax_number": "561-207-7843"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3055 CARDINAL DR STE 301",
            "city": "VERO BEACH",
            "state": "FL",
            "postal_code": "329634925",
            "telephone_number": "772-249-0606",
            "fax_number": "772-673-6112"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACTIVA HEALTH SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-04",
        "last_updated": "2024-05-20",
        "certification_date": "2024-05-20",
        "status": "A",
        "authorized_official_last_name": "LYNCH",
        "authorized_official_first_name": "MARCELLA",
        "authorized_official_title_or_position": "SVP OF COMPLIANCE",
        "authorized_official_telephone_number": "470-392-9412"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "FL",
            "license": "299993848",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Activa Home Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Vero Beach, FL

Sources for this page

Verify at the official NPI Registry.