Healthcare Provider Details

I. General information

NPI: 1013976976
Provider Name (Legal Business Name): ODYSSEY HOUSE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 01/12/2026
Certification Date: 01/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

953 SOUTHERN BLVD RM 301
BRONX NY
10459-3428
US

IV. Provider business mailing address

120 WALL ST STE 1700
NEW YORK NY
10005-4001
US

V. Phone/Fax

Practice location:
  • Phone: 718-860-2994
  • Fax:
Mailing address:
  • Phone: 212-361-1600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: CHIYO JIKKO
Title or Position: ASSISTANT CONTROLLER
Credential:
Phone: 212-361-1600