Provider Demographics
NPI:1902833825
Name:GENTIVA HEALTH SERVICES (USA), LLC
Entity Type:Organization
Organization Name:GENTIVA HEALTH SERVICES (USA), LLC
Other - Org Name:KINDRED AT HOME V
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 1:804 E JACKSON ST
Practice Address - Street 2:
Practice Address - City:HUGO
Practice Address - State:OK
Practice Address - Zip Code:74743-4222
Practice Address - Country:US
Practice Address - Phone:580-326-8376
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-27
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100260400UMedicaid
OK100260400EMedicaid
17029OtherOK-COMMERCIAL NUMBER
B45126453331OtherOK-COMMERCIAL NUMBER
100260400COtherOK-COMMERCIAL NUMBER
112645333186OtherOK-CHAMPUS
OK100260400AMedicaid
OK100260400MMedicaid
1020616OtherOK-COMMERCIAL NUMBER
000377146002OtherOK-COMMERCIAL NUMBER
112645333OtherOK-COMMERCIAL NUMBER
2366169OtherOK-COMMERCIAL NUMBER
GA0177OtherOK-COMMERCIAL NUMBER
100260400BOtherOK-COMMERCIAL NUMBER
ANC015OtherOK-COMMERCIAL NUMBER
013100POtherOK-COMMERCIAL NUMBER
OK100260400LMedicaid
377146OtherOK-COMMERCIAL NUMBER
7559146OtherOK-COMMERCIAL NUMBER