Provider Demographics
NPI:1063713865
Name:ODYSSEY HOUSE INC. LA
Entity type:Organization
Organization Name:ODYSSEY HOUSE INC. LA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LEIGH
Authorized Official - Middle Name:A
Authorized Official - Last Name:DE MONREDON
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:504-220-2194
Mailing Address - Street 1:1125 N TONTI ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119-3549
Mailing Address - Country:US
Mailing Address - Phone:504-378-7816
Mailing Address - Fax:504-371-5162
Practice Address - Street 1:1125 N TONTI ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-3549
Practice Address - Country:US
Practice Address - Phone:504-378-7816
Practice Address - Fax:504-371-5162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-10
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP094186261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center