ODYSSEY HOUSE CORP (NPI# 1194164525) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1194164525 |
| Entity Type | Organization |
| Organization Name | ODYSSEY HOUSE CORP |
| Practice Address |
623 S 200 E Salt Lake City UT 84111-3801 |
| Mailing Address |
344 E 100 S Suite 301 Salt Lake City UT 84111-1700 |
| Practice Telephone | 9287089615 |
| Enumeration Date | 2013-06-19 |
| Last Update Date | 2013-06-19 |
| 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 | 323P00000X | Psychiatric Residential Treatment Facility | Residential Treatment Facilities | ||
| Y | 324500000X | Substance Abuse Rehabilitation Facility | Residential Treatment Facilities |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 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 |
| 1053750760 | Odyssey House Corp | Residential Treatment Facility, Emotionally Disturbed Children | 607 E 200 S, Salt Lake City, UT 84102-2110 | 2013-06-17 |
| 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 |
623 S 200 E |
| City | SALT LAKE CITY |
| State | UT |
| Zip Code | 84111-3801 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316551336 | Mary Ann Rush | Case Manager/Care Coordinator | 334 E. 100 S., Slc, UT 84111 | 2020-09-08 |
| 1790396554 | Stephanie G Mishenko | Military Health Care Provider | 344e 100s, Slc, UT 84111 | 2020-08-13 |
| 1386264802 | Mckensee M Carter | Case Manager/Care Coordinator | 334 E 100 S, Salt Lake City, UT 84111 | 2020-04-24 |
| 1316421761 | Community Health Centers, Inc. | Social Worker | 610 S 200 E Ste #b, Salt Lake City, UT 84111 | 2018-09-21 |
| 1528545506 | Lauren Brittney Harman | Case Manager/Care Coordinator | 344 E. 100 S., Salt Lake City, UT 84111 | 2018-07-23 |
| 1851896484 | Shivani Chowdhary | Dentist | 370 E South Temple Ste 350, Salt Lake City, UT 84111 | 2018-03-26 |
| 1801390661 | Jaylee Marie Watman | Case Manager/Care Coordinator | 344 E. 100 S. Ste 301, Salt Lake City, UT 84111 | 2018-03-19 |
| 1467963918 | Victoira Julia Graham | Case Management | 344 East 100 South Ste 301, Salt Lake City, UT 84111 | 2017-10-23 |
| 1750805404 | Kayla Hymas | Behavioral Analyst | 243 E. 400 S., Slc, UT 84111 | 2017-08-02 |
| 1134643224 | Julie Peaslee | Counselor | 275 E South Temple Ste 110, Salt Lake City, UT 84111 | 2017-07-31 |
| Find all providers in zip 84111 | ||||
| Taxonomy Code | 324500000X |
| Grouping | Residential Treatment Facilities |
| Classification | Substance Abuse Rehabilitation Facility |
| A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances. |
| Notes: [7/1/2003: modified title, modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063013886 | Brc Wellness LLC | Substance Abuse Rehabilitation Facility | 4911 S 900 E Ste B, Salt Lake City, UT 84117-5747 | 2020-11-06 |
| 1528444999 | Jrl Broken Arrow LLC | Substance Abuse Rehabilitation Facility | 2610 S Highland Dr, Salt Lake City, UT 84106-2714 | 2015-08-07 |
| 1962891978 | Chris Ostler | Substance Abuse Rehabilitation Facility | 344 East 100 South,ste 301, Salt Lake City, UT 84111 | 2015-01-14 |
| 1144641564 | Ebh Southwest Services, Inc. | Substance Abuse Rehabilitation Facility | 8072 S Highland Dr, Salt Lake City, UT 84121-5037 | 2014-01-02 |
| 1093152290 | Sober Living Properties | Substance Abuse Rehabilitation Facility | 1027 E Millcreek Way, Salt Lake City, UT 84106-2015 | 2013-05-29 |
| 1831482231 | Project Recovery, Inc. | Substance Abuse Rehabilitation Facility | 1338 Foothill Dr, 162, Salt Lake City, UT 84108-2321 | 2011-05-18 |
| 1043515364 | The Haven | Substance Abuse Rehabilitation Facility | 1450 S West Temple, Apt F 304, Salt Lake City, UT 84115-5203 | 2011-01-18 |
| 1326358599 | Odyssey House | Substance Abuse Rehabilitation Facility | 340 East 100 South, Odyssey House, Salt Lake City, UT 84111 | 2010-10-20 |
| 1861524464 | Journey At Willowcreek | Substance Abuse Rehabilitation Facility | 8072 Highland Dr, Salt Lake City, UT 84121-5037 | 2007-03-09 |
| 1164521852 | Helping Hand Association | Substance Abuse Rehabilitation Facility | 974 East South Temple, Salt Lake City, UT 84102-1413 | 2006-09-21 |
| Find all providers in SALT LAKE CITY | ||||
| City | SALT LAKE CITY |
| Zip Code | 84111 |
Please comment or provide details below to improve the information on ODYSSEY HOUSE CORP.
| 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.