Provider Demographics
NPI:1699776187
Name:ODYSSEY HEALTHCARE OPERATING B LP
Entity type:Organization
Organization Name:ODYSSEY HEALTHCARE OPERATING B LP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP OF LICENSURE
Authorized Official - Prefix:MS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:COMBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-664-2876
Mailing Address - Street 1:PO BOX 4060
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-4060
Mailing Address - Country:US
Mailing Address - Phone:704-664-2876
Mailing Address - Fax:704-664-1306
Practice Address - Street 1:2374 POST ROAD
Practice Address - Street 2:SUITE 206
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-2270
Practice Address - Country:US
Practice Address - Phone:401-738-1492
Practice Address - Fax:401-738-4029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIOH54245Medicaid
RI1699776187Medicaid