MEDICARE: ODEDRA ENTERPRISES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	282E00000X	Long Term Care Hospital
2	3336L0003X	Long Term Care Pharmacy

General Provider Information

NPI Number	:	1033766282
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ODEDRA ENTERPRISES, INC.

Provider Business Mailing Address
First Line	:	2809 OLIVE HWY STE 160
Second Line	:
City	:	OROVILLE
State	:	CA
Zip	:	95966-6133
Country	:	US
Telephone Number	:	530-533-1545
Fax Number	:

Provider Business Practice Location Address
First Line	:	2809 OLIVE HWY STE 160
Second Line	:
City	:	OROVILLE
State	:	CA
Zip	:	95966-6133
Country	:	US
Telephone Number	:	530-533-1545
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	BETTY L RIDDLE
Credential	:
Telephone Number	:	530-588-1325

Provider Enumeration Date	:	08/22/2019
Last Update Date	:	10/14/2020

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Directions to “ODEDRA ENTERPRISES, INC. ” Practice Location

Language	Start Address	Practice Location

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