1053312033 NPI number — ODYSSEY HEALTHCARE OPERATING A LP

Table of content: (NPI 1053312033)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053312033 NPI number — ODYSSEY HEALTHCARE OPERATING A LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ODYSSEY HEALTHCARE OPERATING A LP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053312033
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/12/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

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

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
301 E VANDERBILT WAY STE 250
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN BERNARDINO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92408-3512
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-888-5000
Provider Business Practice Location Address Fax Number:
909-888-4040
Provider Enumeration Date:
08/02/2005

Additional Information

Authorized Official

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

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: HPC01593H , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com