Provider Demographics
NPI:1841630456
Name:ODYSSEY EDUCATION ACADEMY INC
Entity type:Organization
Organization Name:ODYSSEY EDUCATION ACADEMY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:SILLAH
Authorized Official - Suffix:
Authorized Official - Credentials:CRC
Authorized Official - Phone:202-499-0885
Mailing Address - Street 1:11738 S LAUREL DR
Mailing Address - Street 2:APT. 4A
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-2940
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11738 S LAUREL DR
Practice Address - Street 2:APT. 4A
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20708-2940
Practice Address - Country:US
Practice Address - Phone:202-499-0885
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-27
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL00117360251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health