- Enrollment id
- O20220601001033
- Enrollment state
- AR
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1467802405
- Multiple npi flag
- N
- Ccn
- 041528
- Associate id
- 4385551035
- Organization name
- ODYSSEY HEALTHCARE OPERATING A LP
- Doing business as name
- GENTIVA
- Incorporation date
- 1998-03-11
- Incorporation state
- DE
- Organization type structure
- PARTNERSHIP
- Proprietary nonprofit
- P
- Address line 1
- 3801 W MAIN ST
- Address line 2
- STE A
- City
- RUSSELLVILLE
- State
- AR
- Zip code
- 728012313