Provider Demographics
NPI:1316973027
Name:GENTIVA CERTIFIED HEALTHCARE CORP.
Entity type:Organization
Organization Name:GENTIVA CERTIFIED HEALTHCARE CORP.
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:
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 1:5906 COMMERCE CENTER DR
Practice Address - Street 2:SUITE C
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444-7870
Practice Address - Country:US
Practice Address - Phone:231-798-1731
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GENTIVA HEALTH SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-24
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
1015680-0001OtherMI-COMMERCIAL NUMBER
1998308OtherMI-COMMERCIAL NUMBER
128028OtherMI-COMMERCIAL NUMBER
MI2887417Medicaid
350197OtherMI-COMMERCIAL NUMBER
HH630017OtherMI-COMMERCIAL NUMBER
MI152887417Medicaid
MI154362643Medicaid
237135OtherMI-COMMERCIAL NUMBER
0E836OtherMI-COMMERCIAL NUMBER
013100POtherMI-COMMERCIAL NUMBER
0E937OtherMI-COMMERCIAL NUMBER
1015681-0001OtherMI-COMMERCIAL NUMBER
1018492OtherMI-COMMERCIAL NUMBER
126683OtherMI-COMMERCIAL NUMBER
MI152887417Medicaid
MI2887417Medicaid
=========000OtherMI-COMMERCIAL NUMBER
MI154362643Medicaid
1998308OtherMI-COMMERCIAL NUMBER