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General NPI Number Information
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NPI Number | 1356797294
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Entity Type | Organization
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Legal Business Name | ODYSSEY HOUSE OF UTAH, INC.
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Dates
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Enumeration Date | 05/10/2016
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Last Update Date | 05/10/2016
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Provider Practice Location Address
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Address Line | 500 N RAINBOW BLVD SUITE 300
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City | LAS VEGAS
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State | NV
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Zip | 89107-1082
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Country | US
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Telephone | 801-428-3407
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Fax |
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Provider Business Mailing Address
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Address Line | 344 E 100 S SUITE 301
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City | SALT LAKE CITY
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State | UT
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Zip | 84111-1700
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Country | US
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Telephone | 801-428-3407
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Fax |
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | MR. BRIAN PILCHER
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Credential |
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Telephone | 801-428-3407
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | NV2015688985
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License Number State | NV
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