=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205143575
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GENTIVA HOME HEALTH CARE SERVICES,INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/08/2010
-----------------------------------------------------
Last Update Date | 09/08/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1523 PARKWAY LN
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76010-5959
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-890-8238
-----------------------------------------------------
Fax | 817-792-3212
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1523 PARKWAY LN
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76010-5959
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-890-8238
-----------------------------------------------------
Fax | 817-792-3212
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/DON
-----------------------------------------------------
Name | MS. NURAT A DOSUNMU
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 972-890-8238
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------