Provider Demographics
NPI:1265165831
Name:ODYSSEY HOUSE LOUISIANA INC
Entity type:Organization
Organization Name:ODYSSEY HOUSE LOUISIANA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
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:
Mailing Address - Fax:
Practice Address - Street 1:1101 SOUTHEAST BLVD
Practice Address - Street 2:
Practice Address - City:MORGAN CITY
Practice Address - State:LA
Practice Address - Zip Code:70380-5933
Practice Address - Country:US
Practice Address - Phone:985-395-6750
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ODYSSEY HOUSE LOUISIANA INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-07-01
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility