Provider Demographics
NPI:1760483747
Name:ODYSSEY HEALTHCARE OPERATING A LP
Entity Type:Organization
Organization Name:ODYSSEY HEALTHCARE OPERATING A LP
Other - Org Name:ODYSSEY HEALTHCARE OF SALT LAKE CITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR VP & CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:B
Authorized Official - Last Name:CANNON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-922-9711
Mailing Address - Street 1:717 N HARWOOD ST
Mailing Address - Street 2:STE 1500
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75201-6538
Mailing Address - Country:US
Mailing Address - Phone:214-922-9711
Mailing Address - Fax:214-922-9752
Practice Address - Street 1:3949 SOUTH 700 EAST
Practice Address - Street 2:SUITE 110
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107
Practice Address - Country:US
Practice Address - Phone:801-293-8700
Practice Address - Fax:801-293-8701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT=========001Medicaid
UT=========001Medicaid