- Enrollment id
- O20030703000007
- Enrollment state
- MI
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1164423703
- Multiple npi flag
- N
- Ccn
- 231564
- Associate id
- 3779490511
- Organization name
- ODYSSEY HEALTHCARE OPERATING B, LP
- Doing business as name
- GENTIVA I
- Incorporation date
- 2001-01-22
- Incorporation state
- DE
- Organization type structure
- OTHER
- Organization other type text
- LIMITED PARTNERSHIP
- Proprietary nonprofit
- P
- Address line 1
- 25925 TELEGRAPH RD
- Address line 2
- STE 102
- City
- SOUTHFIELD
- State
- MI
- Zip code
- 480332527