Healthcare Provider Details

I. General information

NPI: 1295892248
Provider Name (Legal Business Name): GENTIVA HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

631 BEACON PKWY W STE 110
BIRMINGHAM AL
35209-3130
US

IV. Provider business mailing address

631 BEACON PKWY W STE 110
BIRMINGHAM AL
35209-3130
US

V. Phone/Fax

Practice location:
  • Phone: 205-945-4859
  • Fax: 205-943-8527
Mailing address:
  • Phone: 205-945-4859
  • Fax: 205-943-8527

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberPTH3241
License Number StateAL

VIII. Authorized Official

Name: MR. MICHAEL BROWN
Title or Position: PHYSICAL THERAPIST
Credential:
Phone: 205-945-4859