Provider Demographics
NPI:1417958380
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:SVP OF LEGAL AND COMPLIANCE
Authorized Official - Prefix:MS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:KLEBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-664-2876
Mailing Address - Street 1:655 BRAWLEY SCHOOL RD STE 200
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-9601
Mailing Address - Country:US
Mailing Address - Phone:704-664-2876
Mailing Address - Fax:704-664-1306
Practice Address - Street 1:105 W FRANKLIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-3719
Practice Address - Country:US
Practice Address - Phone:972-232-1890
Practice Address - Fax:972-296-0467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-02
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001004555Medicaid
451699Medicare Oscar/Certification