Provider Demographics
NPI:1093742918
Name:GENTIVA CERTIFIED HEALTHCARE CORP.
Entity Type:Organization
Organization Name:GENTIVA CERTIFIED HEALTHCARE CORP.
Other - Org Name:KINDRED AT HOME III
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 1:5314 S YALE AVE
Practice Address - Street 2:SUITE 500
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-6256
Practice Address - Country:US
Practice Address - Phone:918-488-6153
Practice Address - Fax:918-488-8048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-27
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100260400 GMedicaid
OK100260400UMedicaid
000377442002OtherOK-COMMERCIAL NUMBER
095190OtherOK-COMMERCIAL NUMBER
100260400COtherOK-COMMERCIAL NUMBER
113414024DOtherOK-COMMERCIAL NUMBER
OK100260400QMedicaid
1020615OtherOK-COMMERCIAL NUMBER
0003032739OtherOK-COMMERCIAL NUMBER
013100POtherOK-COMMERCIAL NUMBER
OK100260400LMedicaid
112135OtherOK-COMMERCIAL NUMBER
2366169OtherOK-COMMERCIAL NUMBER
29109OtherOK-COMMERCIAL NUMBER
OK100260400AMedicaid
100260400BOtherOK-COMMERCIAL NUMBER
OK100260400GMedicaid
100260400BOtherOK-COMMERCIAL NUMBER
100260400COtherOK-COMMERCIAL NUMBER
OK100260400LMedicaid