MEDICARE: ODYSSEY HEALTHCARE HOLDING COMPANY

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

General Provider Information

NPI Number	:	1093415762
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ODYSSEY HEALTHCARE HOLDING COMPANY

Provider Business Mailing Address
First Line	:	PO BOX 4060
Second Line	:
City	:	MOORESVILLE
State	:	NC
Zip	:	28117-4060
Country	:	US
Telephone Number	:	704-664-2876
Fax Number	:	704-230-0946

Provider Business Practice Location Address
First Line	:	8130 BAYMEADOWS WAY W STE 201
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-7451
Country	:	US
Telephone Number	:	904-737-2553
Fax Number	:

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

Provider Enumeration Date	:	03/09/2023
Last Update Date	:	12/29/2025

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