Provider Demographics
NPI:1598791295
Name:GENTIVA CERTIFIED HEALTHCARE CORP.
Entity Type:Organization
Organization Name:GENTIVA CERTIFIED HEALTHCARE CORP.
Other - Org Name:KINDRED AT HOME
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 1:1900 INDIAN WOOD CIRCLE
Practice Address - Street 2:SUITE 100A
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-4039
Practice Address - Country:US
Practice Address - Phone:419-482-6519
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0928652Medicaid
367520Medicare Oscar/Certification
115712OtherOH-COMMERCIAL NUMBER
235397OtherOH-COMMERCIAL NUMBER
391OtherOH-COMMERCIAL NUMBER
4445183OtherOH-COMMERCIAL NUMBER
=========-19OtherOH-COMMERCIAL NUMBER
0E801OtherOH-COMMERCIAL NUMBER
1016424OtherOH-COMMERCIAL NUMBER
=========106OtherOH-CHAMPUS
OH0928652Medicaid
367520Medicare Oscar/Certification
000000251685OtherOH-COMMERCIAL NUMBER
=========126OtherOH-CHAMPUS
112135OtherOH-COMMERCIAL NUMBER
=========004OtherOH-COMMERCIAL NUMBER
0003019448OtherOH-COMMERCIAL NUMBER
367520OtherOH-COMMERCIAL NUMBER
14558OtherOH-COMMERCIAL NUMBER
=========OtherOH-COMMERCIAL NUMBER