Provider Demographics
NPI:1912932948
Name:HOSPICE OF THE PALM COAST INC
Entity Type:Organization
Organization Name:HOSPICE OF THE PALM COAST INC
Other - Org Name:ODYSSEY HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR VP & CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:DIRK
Authorized Official - Last Name:ALLISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-922-9711
Mailing Address - Street 1:717 N HARWOOD ST
Mailing Address - Street 2:SUITE 1500
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75201-6519
Mailing Address - Country:US
Mailing Address - Phone:214-922-9711
Mailing Address - Fax:214-922-9752
Practice Address - Street 1:6161 BLUE LAGOON DRIVE
Practice Address - Street 2:SUITE 170
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-2045
Practice Address - Country:US
Practice Address - Phone:786-388-1400
Practice Address - Fax:786-388-1401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL50370970251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL150019800Medicaid
101548Medicare Oscar/Certification