Provider Demographics
NPI:1013976976
Name:ODYSSEY HOUSE, INC
Entity type:Organization
Organization Name:ODYSSEY HOUSE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:CHIYO
Authorized Official - Middle Name:
Authorized Official - Last Name:JIKKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-361-1600
Mailing Address - Street 1:120 WALL ST STE 1700
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10005-4001
Mailing Address - Country:US
Mailing Address - Phone:212-361-1600
Mailing Address - Fax:
Practice Address - Street 1:953 SOUTHERN BLVD RM 301
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10459-3428
Practice Address - Country:US
Practice Address - Phone:718-860-2994
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-20
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility