Provider Demographics
NPI:1013225192
Name:ODESSA HOME HEALTHCARE LLC
Entity Type:Organization
Organization Name:ODESSA HOME HEALTHCARE LLC
Other - Org Name:ODESSA HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERATION MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRINA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:WADE
Authorized Official - Suffix:
Authorized Official - Credentials:EMTP
Authorized Official - Phone:866-681-7514
Mailing Address - Street 1:3867 KENTUCKY DERBY DR
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63034-3326
Mailing Address - Country:US
Mailing Address - Phone:314-749-3067
Mailing Address - Fax:
Practice Address - Street 1:3867 KENTUCKY DERBY DR
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63034-3326
Practice Address - Country:US
Practice Address - Phone:314-749-3067
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-22
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health