Provider Demographics
NPI:1629327556
Name:ODYSSEY SERVICES CORP.
Entity Type:Organization
Organization Name:ODYSSEY SERVICES CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARTI
Authorized Official - Middle Name:CIES
Authorized Official - Last Name:DEPUE
Authorized Official - Suffix:
Authorized Official - Credentials:MS ED
Authorized Official - Phone:602-451-4799
Mailing Address - Street 1:8947 EAST QUILL STREET
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85207
Mailing Address - Country:US
Mailing Address - Phone:480-988-1189
Mailing Address - Fax:480-988-3068
Practice Address - Street 1:8947 EAST QUILL STREET
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85207
Practice Address - Country:US
Practice Address - Phone:480-988-1189
Practice Address - Fax:480-988-3068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-06
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health