Provider Demographics
NPI:1811351307
Name:ODYSSEY HOUSE, INC.
Entity type:Organization
Organization Name:ODYSSEY HOUSE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR MANAGER, DIRECTOR OF OUTPATI
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:CARITAS
Authorized Official - Last Name:CALLAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:718-860-2994
Mailing Address - Street 1:953 SOUTHERN BLVD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10459-3428
Mailing Address - Country:US
Mailing Address - Phone:718-860-2994
Mailing Address - Fax:718-860-4479
Practice Address - Street 1:953 SOUTHERN BLVD
Practice Address - Street 2:SUITE 301
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:718-860-4479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-11
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP056639-1251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health