Provider Demographics
NPI:1376574384
Name:HOME HOSPICE OF ODESSA/MIDLAND, LLC
Entity Type:Organization
Organization Name:HOME HOSPICE OF ODESSA/MIDLAND, LLC
Other - Org Name:HOME HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:C.
Authorized Official - Middle Name:LANELL
Authorized Official - Last Name:WEBB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:432-580-9990
Mailing Address - Street 1:601 E 2ND ST STE F
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761-5423
Mailing Address - Country:US
Mailing Address - Phone:432-580-9990
Mailing Address - Fax:432-580-9989
Practice Address - Street 1:601 E 2ND ST STE F
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-5423
Practice Address - Country:US
Practice Address - Phone:432-580-9990
Practice Address - Fax:432-580-9989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX003840251G00000X, 251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000218500Medicaid
TX000218500Medicaid
TX000218500Medicaid