Healthcare Provider Details

I. General information

NPI: 1245729045
Provider Name (Legal Business Name): ODYSSEY HOUSE LOUISIANA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2018
Last Update Date: 02/17/2023
Certification Date: 02/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 S BROAD ST
NEW ORLEANS LA
70125-1953
US

IV. Provider business mailing address

1125 N TONTI ST
NEW ORLEANS LA
70119-3549
US

V. Phone/Fax

Practice location:
  • Phone: 504-821-9211
  • Fax: 504-821-0196
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: AMY BRIGGS BOSWORTH
Title or Position: PROGRAM DIRECTOR
Credential:
Phone: 504-821-9211