Provider Demographics
NPI:1477151579
Name:ODEDRA ENTERPRISES, INC.
Entity Type:Organization
Organization Name:ODEDRA ENTERPRISES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:L
Authorized Official - Last Name:RIDDLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-588-1325
Mailing Address - Street 1:2809 OLIVE HWY STE 160
Mailing Address - Street 2:
Mailing Address - City:OROVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95966-6133
Mailing Address - Country:US
Mailing Address - Phone:530-588-1325
Mailing Address - Fax:
Practice Address - Street 1:2809 OLIVE HWY STE 160
Practice Address - Street 2:
Practice Address - City:OROVILLE
Practice Address - State:CA
Practice Address - Zip Code:95966-6133
Practice Address - Country:US
Practice Address - Phone:530-588-1325
Practice Address - Fax:530-660-4551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-12
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies