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

General Provider Information

NPI Number	:	1215636709
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	:
City	:	MOORESVILLE
State	:	NC
Zip	:	28117-4060
Country	:	US
Telephone Number	:	704-664-2876
Fax Number	:

Provider Business Practice Location Address
First Line	:	181 METRO DR STE 540
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95110-1346
Country	:	US
Telephone Number	:	408-450-7850
Fax Number	:	408-986-0354

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

Provider Enumeration Date	:	02/23/2023
Last Update Date	:	10/10/2024

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