Provider Demographics
NPI:1689600389
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 1:3240 EL CAMINO REAL
Practice Address - Street 2:SUITE 190
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92602-1383
Practice Address - Country:US
Practice Address - Phone:714-505-3087
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
11-3414024OtherCA-COMMERCIAL NUMBER
060000282OtherCA-COMMERCIAL NUMBER
48-0938087OtherCA-COMMERCIAL NUMBER
CAHHA07896GMedicaid
106825025OtherCA-COMMERCIAL NUMBER
2118952OtherCA-COMMERCIAL NUMBER
013100POtherCA-COMMERCIAL NUMBER
113414024OtherCA-COMMERCIAL NUMBER
55-7104OtherCA-COMMERCIAL NUMBER
CA55-7104Medicaid
557104OtherCA-COMMERCIAL NUMBER
113414024FOtherCA-COMMERCIAL NUMBER
114543OtherCA-COMMERCIAL NUMBER
120243OtherCA-COMMERCIAL NUMBER
1500992OtherCA-COMMERCIAL NUMBER
113414024OtherCA-COMMERCIAL NUMBER
1500992OtherCA-COMMERCIAL NUMBER
557104OtherCA-COMMERCIAL NUMBER