ODYSSEY HOUSE CORP (NPI# 1053750760) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1053750760 |
| Entity Type | Organization |
| Organization Name | ODYSSEY HOUSE CORP |
| Practice Address |
607 E 200 S Salt Lake City UT 84102-2110 |
| Mailing Address |
344 E 100 S Suite 301 Salt Lake City UT 84111-1700 |
| Practice Telephone | 9287089615 |
| Enumeration Date | 2013-06-17 |
| Last Update Date | 2013-06-17 |
| Authorized Official Name | MATTHEW LUCHINI (ACCOUNT MANAGER) |
| Authorized Official Telephone | 9285334220 |
| Is Organization Subpart | Y |
| Parent Organization Name | ODYSSEY HOUSE CORP |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 322D00000X | Residential Treatment Facility, Emotionally Disturbed Children | Residential Treatment Facilities | ||
| Y | 3245S0500X |
Substance Abuse Rehabilitation Facility Specialization: Substance Abuse Treatment, Children |
Residential Treatment Facilities |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194164525 | Odyssey House Corp | Psychiatric Residential Treatment Facility | 623 S 200 E, Salt Lake City, UT 84111-3801 | 2013-06-19 |
| 1104265537 | Odyssey House Corp | Substance Abuse Rehabilitation Facility | 68 S 600 E, Salt Lake City, UT 84102-1007 | 2013-06-19 |
| 1386083715 | Odyssey House Corp | Psychiatric Residential Treatment Facility | 42 S 500 E, Salt Lake City, UT 84102-1002 | 2013-06-19 |
| 1326487026 | Odyssey House Corp | Residential Treatment Facility, Emotionally Disturbed Children | 880 E 3375 S, Salt Lake City, UT 84106-1536 | 2013-06-17 |
| Street Address |
607 E 200 S |
| City | SALT LAKE CITY |
| State | UT |
| Zip Code | 84102-2110 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346568763 | Megan Gailey | Social Worker | 607 E 200 S, Salt Lake City, UT 84102-2110 | 2010-05-10 |
| 1699375725 | Natania Raquel Taub | Residential Treatment Facility, Emotionally Disturbed Children | 607 E 200 S, Salt Lake City, UT 84102-2110 | 2020-10-28 |
| 1538777388 | Willie Gene Dennis | Case Manager/Care Coordinator | 607 E 200 S, Salt Lake City, UT 84102-2110 | 2020-07-17 |
| 1588065767 | Ellen Grace Hibdon | Community Health Worker | 607 E 200 S, Salt Lake City, UT 84102-2110 | 2014-09-08 |
| 1912332172 | Andrew Belmont | Social Worker | 607 E 200 S, Salt Lake City, UT 84102-2110 | 2013-09-06 |
| 1780027987 | April Dineen | Social Worker | 607 E 200 S, Salt Lake City, UT 84102-2110 | 2013-04-08 |
| 1487994182 | Sharlynn Curtis | Social Worker | 607 E 200 S, Salt Lake City, UT 84102-2110 | 2013-02-18 |
| 1467702217 | Michael Sistrunk | Social Worker | 607 E 200 S, Salt Lake City, UT 84102-2110 | 2012-09-19 |
| 1255689014 | Annessa Heaton | Social Worker | 607 E 200 S, Salt Lake City, UT 84102-2110 | 2012-08-27 |
| 1144578907 | Olosaa Solovi | Social Worker | 607 E 200 S, Salt Lake City, UT 84102-2110 | 2012-08-27 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942818604 | Wendy Vazquez | Behavior Technician | 515 S 700 E Suit 2a, Salt Lake City, UT 84102 | 2020-07-20 |
| 1407481245 | Odyssey House Inc | Family Medicine | 743 E 300 S, Salt Lake City, UT 84102 | 2020-03-11 |
| 1093359960 | Hayle Mayer | Behavior Technician | 515 S 700 E Salt Lake City, Suite 2a, Salt Lake, UT 84102 | 2019-11-04 |
| 1326680869 | Ronald Mcdonald House of The Intermountain Area | Meals | 935 E. South Temple, Salt Lake City, UT 84102 | 2019-10-16 |
| 1508419581 | Claire Pemberton | Behavior Technician | 327 E 1300 S, Apt 2, Salt Lake City, UT 84102 | 2019-07-19 |
| 1558923144 | Olivia Anne Hardwick | Social Worker | Transitions At Slrmc, 86 S. 1100 E. Suite 404, Salt Lake City, UT 84102 | 2019-07-03 |
| 1649741802 | Colten Vancampen | Behavior Technician | 515 S 700 E #2a, Salt Lake City, UT 84102 | 2018-12-16 |
| 1457847964 | Utah Podiatry Group PC | Podiatrist | 24 S 1100 E Ste 120, Salt Lake City, UT 84102 | 2018-07-09 |
| 1104311661 | Malorey Kooyman | Behavior Technician | 515 700 East, Suite 2a, Salt Lake City, UT 84102 | 2018-06-27 |
| 1700384930 | Utah Podiatry Group PC | Podiatrist | 82 S 1100 E Ste 301, Salt Lake City, UT 84102 | 2018-01-23 |
| Find all providers in zip 84102 | ||||
| Taxonomy Code | 3245S0500X |
| Grouping | Residential Treatment Facilities |
| Classification | Substance Abuse Rehabilitation Facility |
| Specialization | Substance Abuse Treatment, Children |
| A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of children with disorders in the use of drugs, alcohol, and other substances. Medical and supportive counseling services and education services are included. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083073985 | Eric Peter Rydzewski | Substance Abuse Rehabilitation Facility | 344 E 100 S, Suite 301, Salt Lake City, UT 84111-1700 | 2016-02-19 |
| 1457697369 | Primary Childrens Medical Center | Substance Abuse Rehabilitation Facility | 5770 South 1500 West, Building A, Salt Lake City, UT 84123 | 2012-12-20 |
| 1801147533 | Craig A. Clifford | Substance Abuse Rehabilitation Facility | 344 E 100 S, Ste 301, Salt Lake City, UT 84111-1700 | 2012-09-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952790099 | Lorraine Michelle Ivey | Substance Abuse Rehabilitation Facility | 115 N 200 E, Washington, UT 84780-1642 | 2015-01-13 |
| 1912328576 | Heather Jenkins | Substance Abuse Rehabilitation Facility | 6200 South 3809 West, Kearns, UT 84129 | 2013-12-30 |
| 1477819878 | Mt Pleasant Campus | Substance Abuse Rehabilitation Facility | 1170 South 70 West, Mt. Pleasant, UT 84647 | 2012-04-10 |
| 1821382318 | Terri Butcher | Substance Abuse Rehabilitation Facility | 66 North 180 West, Ephriam, UT 84627-1111 | 2011-06-02 |
| 1154641926 | Triumph Youth Services | Substance Abuse Rehabilitation Facility | 58 S 950 W, Brigham City, UT 84302-4424 | 2010-06-03 |
| 1922323203 | Catalyst Residential Treatment | Substance Abuse Rehabilitation Facility | 970 S 1025 W, Brigham City, UT 84302-6711 | 2010-03-30 |
| 1003014648 | Eagle Ranch Academy | Substance Abuse Rehabilitation Facility | 115 W 1470 S, St George, UT 84770-6763 | 2007-07-05 |
| 1780782508 | Northstar Youth Academy LLC | Substance Abuse Rehabilitation Facility | 900 Columbia Ln, Provo, UT 84604-1320 | 2006-09-20 |
| 1639565260 | Salt Creek Addiction Recovery Services | Substance Abuse Rehabilitation Facility | 21360 N 1450 E, Moroni, UT 84646 | 2015-04-10 |
| 1396169728 | Apex Youth Services | Substance Abuse Rehabilitation Facility | 8606 N 11600 W, Thatcher, UT 84337-9103 | 2014-02-05 |
| Find all providers with the same taxonomy | ||||
| City | SALT LAKE CITY |
| Zip Code | 84102 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.