=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053337238
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ODYSSEY HEALTHCARE OPERATING A LP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/14/2006
-----------------------------------------------------
Last Update Date | 04/20/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6801 SPRING CREEK RD SUITE 2C
-----------------------------------------------------
City | ROCKFORD
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 61114-7420
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 815-637-2200
-----------------------------------------------------
Fax | 815-637-2900
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 717 N HARWOOD ST STE 1500
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75201-6519
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-922-9711
-----------------------------------------------------
Fax | 214-922-9752
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SR VP & CFO
-----------------------------------------------------
Name | MR. RODNEY DIRK ALLISON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 214-922-9711
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251G00000X
-----------------------------------------------------
Taxonomy Name | Community Based Hospice Care Agency
-----------------------------------------------------
License Number | 2002483
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------