Provider Demographics
NPI:1235705575
Name:ODYSSEY HEALTHCARE OPERATING A, LP
Entity Type:Organization
Organization Name:ODYSSEY HEALTHCARE OPERATING A, LP
Other - Org Name:KINDRED HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP LICENSURE
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:COMBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-814-2013
Mailing Address - Street 1:PO BOX 4060
Mailing Address - Street 2:ATTN: REGULATORY
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:
Practice Address - Street 1:16070 TUSCOLA RD STE 204
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-1691
Practice Address - Country:US
Practice Address - Phone:760-241-7044
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ODYSSEY HEALTHCARE OPERATING A, LP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-05-27
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHPC01593HMedicaid