- Enrollment id
- O20091021000682
- Enrollment state
- FL
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1114159902
- Multiple npi flag
- N
- Ccn
- 101548
- Associate id
- 7315084480
- Organization name
- ODYSSEY HEALTHCARE OF MARION COUNTY, LLC
- Doing business as name
- GENTIVA
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 6161 BLUE LAGOON DR
- Address line 2
- STE 170
- City
- MIAMI
- State
- FL
- Zip code
- 331262045