- Enrollment id
- O20050801000509
- Enrollment state
- NC
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1528015369
- Multiple npi flag
- N
- Ccn
- 341576
- Associate id
- 5597793596
- Organization name
- CARROLTON HOME CARE, LLC
- Doing business as name
- GENTIVA
- Incorporation date
- 1994-01-07
- Incorporation state
- DE
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 2800 BREEZEWOOD AVE
- Address line 2
- STE 100
- City
- FAYETTEVILLE
- State
- NC
- Zip code
- 283035282