1033141205 NPI number — GENTIVA HEALTH SERVICES (USA), LLC

Table of content: (NPI 1033141205)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033141205 NPI number — GENTIVA HEALTH SERVICES (USA), LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GENTIVA HEALTH SERVICES (USA), LLC
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 I
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:
1033141205
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/13/2017
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:
2210 W GORE BLVD
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
LAWTON
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73501-3652
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-248-9998
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/07/2006

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: ANC015 . This is a "OK-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: GA0962 . This is a "OK-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1500992 . This is a "OK-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: B2126453331 . This is a "OK-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000377164002 . This is a "OK-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 112645333169 . This is a "OK-CHAMPUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 112645333 . This is a "OK-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 100260400B . This is a "OK-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 100260400U , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 377164 . This is a "OK-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 013100P . This is a "OK-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 100260400C . This is a "OK-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1020620 . This is a "OK-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7559146 . This is a "OK-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: G1126453331 , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2366169 . This is a "OK-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".




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