Healthcare Provider Details

I. General information

NPI: 1629079207
Provider Name (Legal Business Name): ODYSSEY HEALTHCARE OPERATING B LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 08/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 WILLIAMS ST
VALDOSTA GA
31601-4038
US

IV. Provider business mailing address

717 N HARWOOD ST SUITE 1500
DALLAS TX
75201-6519
US

V. Phone/Fax

Practice location:
  • Phone: 229-249-8687
  • Fax: 229-249-9282
Mailing address:
  • Phone: 214-922-9711
  • Fax: 214-922-9752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number092194H
License Number StateGA

VIII. Authorized Official

Name: MR. RODNEY DIRK ALLISON
Title or Position: SR VP & CFO
Credential:
Phone: 214-922-9711