Healthcare Provider Details

I. General information

NPI: 1851990907
Provider Name (Legal Business Name): ODYSSEY HEALTHCARE OPERATING A LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2020
Last Update Date: 03/29/2021
Certification Date: 03/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5080 SHOREHAM PL STE 105
SAN DIEGO CA
92122-5931
US

IV. Provider business mailing address

PO BOX 4060 ATTN: REGULATORY
MOORESVILLE NC
28117-4060
US

V. Phone/Fax

Practice location:
  • Phone: 858-565-2499
  • Fax:
Mailing address:
  • Phone: 704-664-2876
  • Fax: 704-664-1306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

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