Basic Information
Provider Information | |||||||||
NPI: | 1952302846 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | ODYSSEY HEALTHCARE OPERATING A LP | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | ODYSSEY HEALTHCARE OF PHILADELPHIA | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 717 N HARWOOD ST | ||||||||
Address2: | SUITE 1500 | ||||||||
City: | DALLAS | ||||||||
State: | TX | ||||||||
PostalCode: | 752016519 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2149229711 | ||||||||
FaxNumber: | 2149229752 | ||||||||
Practice Location | |||||||||
Address1: | 512 TOWNSHIP LINE RD | ||||||||
Address2: | BUILDING 2 VALLEY SQUARE SUITE 305 | ||||||||
City: | BLUE BELL | ||||||||
State: | PA | ||||||||
PostalCode: | 194222700 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2156197710 | ||||||||
FaxNumber: | 2156197740 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/02/2005 | ||||||||
LastUpdateDate: | 08/01/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | ALLISON | ||||||||
AuthorizedOfficialFirstName: | RODNEY | ||||||||
AuthorizedOfficialMiddleName: | DIRK | ||||||||
AuthorizedOfficialTitleorPosition: | SR VP & CFO | ||||||||
AuthorizedOfficialTelephone: | 2149229711 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | MR. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251G00000X | 16461601 | PA | Y |   | Agencies | Hospice Care, Community Based |   |
ID Information
ID | Type | State | Issuer | Description | 0019101900005 | 05 | PA |   | MEDICAID |