1689600389 NPI number — GENTIVA CERTIFIED HEALTHCARE CORP.

Table of content: (NPI 1689600389)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689600389 NPI number — GENTIVA CERTIFIED HEALTHCARE CORP.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GENTIVA CERTIFIED HEALTHCARE CORP.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
KINDRED AT HOME
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689600389
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/29/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12900 FOSTER ST STE 400
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OVERLAND PARK
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66213-2696
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3240 EL CAMINO REAL
Provider Second Line Business Practice Location Address:
SUITE 190
Provider Business Practice Location Address City Name:
IRVINE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92602-1383
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-505-3087
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SCHWARTZ
Authorized Official First Name:
RUTH
Authorized Official Middle Name:
Authorized Official Title or Position:
ASSISTANT SECRETARY
Authorized Official Telephone Number:
913-814-2288

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 11-3414024 . This is a "CA-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 060000282 . This is a "CA-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 48-0938087 . This is a "CA-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: HHA07896G , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 106825025 . This is a "CA-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2118952 . This is a "CA-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 013100P . This is a "CA-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 113414024 . This is a "CA-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 55-7104 . This is a "CA-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 55-7104 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 557104 . This is a "CA-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 113414024F . This is a "CA-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 114543 . This is a "CA-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 120243 . This is a "CA-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1500992 . This is a "CA-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".




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