MEDICARE: ODYSSEY HEALTHCARE OPERATING B, 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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265433718
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ODYSSEY HEALTHCARE OPERATING B, LP

Provider Business Mailing Address
First Line	:	655 BRAWLEY SCHOOL RD STE 200
Second Line	:
City	:	MOORESVILLE
State	:	NC
Zip	:	28117-9601
Country	:	US
Telephone Number	:	704-664-2876
Fax Number	:	704-664-1306

Provider Business Practice Location Address
First Line	:	808 MOOREFIELD PARK DR STE 113
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23236-3673
Country	:	US
Telephone Number	:	804-290-4300
Fax Number	:	804-282-4535

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

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	01/17/2023

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