MEDICARE: ODYSSEY HEALTHCARE OPERATING A LP

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	251G00000X	Community Based Hospice Care Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043211931
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ODYSSEY HEALTHCARE OPERATING A LP

Provider Business Mailing Address
First Line	:	PO BOX 4060
Second Line	:	ATTN REGULATORY
City	:	MOORESVILLE
State	:	NC
Zip	:	28117-4060
Country	:	US
Telephone Number	:	704-664-2876
Fax Number	:	704-664-1306

Provider Business Practice Location Address
First Line	:	36947 COOK ST
Second Line	:	BLDG. 10, SUITE 102
City	:	PALM DESERT
State	:	CA
Zip	:	92211-6078
Country	:	US
Telephone Number	:	760-346-2816
Fax Number	:	760-674-1707

Authorized Official
Title or Position	:	VP OF LICENSURE
Name	:	JANET COMBS
Credential	:
Telephone Number	:	704-662-1761

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	06/22/2023

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