Basic Information
| Provider Information | |||||||||
| NPI: | 1093747347 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | GENTIVA CERTIFIED HEALTHCARE CORP. | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | CENTERWELL HOME HEALTH | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 6330 SPRINT PKWY STE 300 | ||||||||
| Address2: | |||||||||
| City: | OVERLAND PARK | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662111157 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9138142716 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 10825 FINANCIAL CENTRE PKWY STE 210 | ||||||||
| Address2: | |||||||||
| City: | LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 722113545 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5012238310 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2006 | ||||||||
| LastUpdateDate: | 09/01/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | SKAGGS | ||||||||
| AuthorizedOfficialFirstName: | LINDA | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | AUTHORIZED OFFICIAL | ||||||||
| AuthorizedOfficialTelephone: | 9138142716 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 09/01/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | Y | Agencies | Home Health |
ID Information
| ID | Type | State | Issuer | Description | 115712 | 01 | AR-COMMERCIAL NUMBER | OTHER | 122835716 | 05 | AR | MEDICAID | 145687732 | 05 | AR | MEDICAID | 0564382 | 01 | AR-COMMERCIAL NUMBER | OTHER | 121950742 | 05 | AR | MEDICAID | 131156742 | 05 | AR | MEDICAID | 17900 | 01 | AR-COMMERCIAL NUMBER | OTHER | 047029 | 01 | AR-COMMERCIAL NUMBER | OTHER | 129059514 | 05 | AR | MEDICAID | 17029 | 01 | AR-COMMERCIAL NUMBER | OTHER | 112135 | 01 | AR-COMMERCIAL NUMBER | OTHER | 129058732 | 05 | AR | MEDICAID | 1500992 | 01 | AR-COMMERCIAL NUMBER | OTHER | 013100P | 01 | AR-COMMERCIAL NUMBER | OTHER | 11341402450 | 01 | AR-COMMERCIAL NUMBER | OTHER | 145488738 | 05 | AR | MEDICAID | 235397 | 01 | AR-COMMERCIAL NUMBER | OTHER |