Provider Demographics
NPI:1942971346
Name:ODYSSEY HEALTHCARE OF MARION COUNTY, LLC
Entity Type:Organization
Organization Name:ODYSSEY HEALTHCARE OF MARION COUNTY, LLC
Other - Org Name:KINDRED HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP REGULATORY & LICENSURE SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:PATIENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-662-0416
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:
Practice Address - Street 1:1975 S JOHN YOUNG PKWY STE 203
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-0605
Practice Address - Country:US
Practice Address - Phone:321-250-6742
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ODYSSEY HEALTHCARE OF MARION COUNTY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-09-24
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL106749100Medicaid