Healthcare Provider Details

I. General information

NPI: 1538362314
Provider Name (Legal Business Name): GENTIVA HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 MURPHY LN
HAMPDEN ME
04444-1724
US

IV. Provider business mailing address

1 CUMBERLAND PL STE 108
BANGOR ME
04401-5087
US

V. Phone/Fax

Practice location:
  • Phone: 207-941-8017
  • Fax:
Mailing address:
  • Phone: 207-990-9000
  • Fax: 207-945-8645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number039741
License Number StateME

VIII. Authorized Official

Name: MRS. CYNTHIA LUCILLE KARRIS
Title or Position: RN
Credential: RN
Phone: 207-990-9000