Provider Demographics
NPI:1134159510
Name:GENTIVA HEALTH SERVICES (CERTIFIED), INC.
Entity type:Organization
Organization Name:GENTIVA HEALTH SERVICES (CERTIFIED), INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:C
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 1:4700 BAYOU BLVD STE 1C
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2670
Practice Address - Country:US
Practice Address - Phone:850-477-5800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
013100POtherG2
107937332OtherG2
11225647902OtherG2
070425OtherG2
1016449OtherG2
235397OtherG2
6000055OtherG2
2117447OtherG2
113414024GOtherG2
146544OtherG2
2338051OtherG2
11-3414024OtherG2
080053OtherG2
112645333OtherG2
=========OtherG2
11225647902OtherG2
=========017Other1H
=========OtherG2
235397OtherG2