- Enrollment id
- O20130131000219
- Enrollment state
- WA
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1689906125
- Multiple npi flag
- N
- Ccn
- 501541
- Associate id
- 3779490511
- Organization name
- ODYSSEY HEALTHCARE OPERATING B, LP
- Doing business as name
- GENTIVA
- Organization type structure
- OTHER
- Organization other type text
- LIMITED PARTNERSHIP
- Proprietary nonprofit
- P
- Address line 1
- 625 ANDOVER PARK W
- Address line 2
- STE 111
- City
- TUKWILA
- State
- WA
- Zip code
- 981883332