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General NPI Number Information
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NPI Number | 1659127256
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Entity Type | Organization
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Legal Business Name | ODYSSEY MEDICAL ASSOCIATES LLC
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Dates
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Enumeration Date | 04/25/2024
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Last Update Date | 04/25/2024
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Provider Practice Location Address
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Address Line | 375 WESTGATE DR
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City | BROCKTON
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State | MA
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Zip | 02301-1818
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Country | US
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Telephone | 857-544-2776
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Fax |
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Provider Business Mailing Address
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Address Line | 500 WESTGATE DR # 1133
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City | BROCKTON
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State | MA
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Zip | 02301-1855
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Country | US
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Telephone | 857-544-2776
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | XAVIER CABAN
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Credential |
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Telephone | 857-544-2776
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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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 | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QR0800X
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Taxonomy Name | Recovery Care Clinic/Center
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License Number |
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License Number State |
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