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General NPI Number Information
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NPI Number | 1407481245
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Entity Type | Organization
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Legal Business Name | ODYSSEY HOUSE INC
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Dates
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Enumeration Date | 03/11/2020
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Last Update Date | 03/11/2020
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Provider Practice Location Address
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Address Line | 743 E 300 S
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City | SALT LAKE CITY
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State | UT
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Zip | 84102
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Country | US
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Telephone | 801-428-3500
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Fax | 801-210-5031
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Provider Business Mailing Address
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Address Line | 344 E 100 S STE 301
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City | SALT LAKE CITY
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State | UT
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Zip | 84111-1727
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Country | US
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Telephone | 801-322-4257
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | ADAM COHEN
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Credential |
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Telephone | 801-428-3449
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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