Provider Demographics
NPI:1508026683
Name:ODYSSEY PRIMARY HOMECARE, INC.
Entity Type:Organization
Organization Name:ODYSSEY PRIMARY HOMECARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DALIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOLINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-287-2600
Mailing Address - Street 1:3224 SOUTH SUGAR ROAD SUITE L
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539
Mailing Address - Country:US
Mailing Address - Phone:956-287-2600
Mailing Address - Fax:956-685-1374
Practice Address - Street 1:3224 SOUTH SUGAR RD. SUITE L
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539
Practice Address - Country:US
Practice Address - Phone:956-287-2600
Practice Address - Fax:956-685-1374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-12
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
TX013402251E00000X, 251J00000X
TX251E00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX360880402Medicaid
TX360880401Medicaid
TX360880401Medicaid