Healthcare Provider Details

I. General information

NPI: 1558977942
Provider Name (Legal Business Name): ODYSSEY HEALTHCARE OPERATING A LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2020
Last Update Date: 09/21/2020
Certification Date: 09/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4120 DUBLIN BLVD STE 105
DUBLIN CA
94568-7759
US

IV. Provider business mailing address

PO BOX 4060
MOORESVILLE NC
28117-4060
US

V. Phone/Fax

Practice location:
  • Phone: 925-737-0203
  • Fax: 925-737-0245
Mailing address:
  • Phone: 704-664-0416
  • Fax: 704-664-1306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name: PATIENCE MCGEE
Title or Position: VP OF REGULATORY & LIC SERVICES
Credential:
Phone: 704-662-0416