Provider Demographics
NPI:1326588864
Name:ODYSSEY HOUSE, INC.
Entity Type:Organization
Organization Name:ODYSSEY HOUSE, INC.
Other - Org Name:ODYSSEY HOUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:JOANNA
Authorized Official - Middle Name:R
Authorized Official - Last Name:WHEELTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-428-3487
Mailing Address - Street 1:2810 W CHARLESTON BLVD STE 70
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-1993
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2810 W CHARLESTON BLVD STE 70
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1993
Practice Address - Country:US
Practice Address - Phone:801-428-3487
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-02
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVSAPTA3245S0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children