Provider Demographics
NPI:1790352367
Name:ODYSSEY HOUSE LOUISIANA, INC
Entity Type:Organization
Organization Name:ODYSSEY HOUSE LOUISIANA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:BRIGGS
Authorized Official - Last Name:BOSWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-821-9211
Mailing Address - Street 1:PO BOX 19576
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70179-0576
Mailing Address - Country:US
Mailing Address - Phone:504-384-2687
Mailing Address - Fax:504-269-3522
Practice Address - Street 1:2700 S BROAD ST STE A
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70125-1953
Practice Address - Country:US
Practice Address - Phone:504-384-2687
Practice Address - Fax:504-269-3522
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ODYSSEY HOUSE LOUISIANA, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-06-10
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy