Provider Demographics
NPI:1326487026
Name:ODYSSEY HOUSE CORP
Entity Type:Organization
Organization Name:ODYSSEY HOUSE CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:LUCHINI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-533-4220
Mailing Address - Street 1:344 E 100 S
Mailing Address - Street 2:SUITE 301
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84111-1700
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:880 E 3375 S
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-1536
Practice Address - Country:US
Practice Address - Phone:928-708-9615
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ODYSSEY HOUSE CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-06-17
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children