MEDICARE: ODYSSEY HEALTHCARE OF MARION COUNTY, LLC

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	:	1114159902
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ODYSSEY HEALTHCARE OF MARION COUNTY, LLC

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	:	704-664-1306

Provider Business Practice Location Address
First Line	:	6161 BLUE LAGOON DR STE 170
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33126-2045
Country	:	US
Telephone Number	:	786-388-1400
Fax Number	:	786-388-1401

Authorized Official
Title or Position	:	VP OF LICENSURE
Name	:	MS. JANET COMBS
Credential	:
Telephone Number	:	704-664-2876

Provider Enumeration Date	:	08/13/2009
Last Update Date	:	01/17/2023

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