Provider Demographics
NPI:1033141205
Name:GENTIVA HEALTH SERVICES (USA), LLC
Entity Type:Organization
Organization Name:GENTIVA HEALTH SERVICES (USA), LLC
Other - Org Name:KINDRED AT HOME I
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHWARTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-814-2288
Mailing Address - Street 1:12900 FOSTER ST STE 400
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66213-2696
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2210 W GORE BLVD
Practice Address - Street 2:SUITE 3
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73501-3652
Practice Address - Country:US
Practice Address - Phone:580-248-9998
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ANC015OtherOK-COMMERCIAL NUMBER
GA0962OtherOK-COMMERCIAL NUMBER
1500992OtherOK-COMMERCIAL NUMBER
B2126453331OtherOK-COMMERCIAL NUMBER
000377164002OtherOK-COMMERCIAL NUMBER
112645333169OtherOK-CHAMPUS
112645333OtherOK-COMMERCIAL NUMBER
100260400BOtherOK-COMMERCIAL NUMBER
OK100260400UMedicaid
377164OtherOK-COMMERCIAL NUMBER
013100POtherOK-COMMERCIAL NUMBER
100260400COtherOK-COMMERCIAL NUMBER
1020620OtherOK-COMMERCIAL NUMBER
7559146OtherOK-COMMERCIAL NUMBER
OKG1126453331Medicaid
2366169OtherOK-COMMERCIAL NUMBER