# ODYSSEY HOUSE INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Odyssey House Martindale Clinic
- **Organization subpart:** No

## Provider details

- **NPI number:** 1407481245
- **Authorized official:** ADAM COHEN (CEO)
- **Authorized official phone:** (801) 428-3449

## Contact information

- **Practice address:** 743 E 300 S, SALT LAKE CITY, UT 84102
- **Practice address phone:** (801) 428-3500
- **Practice address fax:** (801) 210-5031
- **Mailing address:** 344 E 100 S STE 301, SALT LAKE CITY, UT 84111-1727
- **Mailing address phone:** (801) 322-4257

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 207QA0401X | Addiction Medicine (Family Medicine) Physician | — | NULL | — |
| 207QA0401X | Addiction Medicine (Family Medicine) Physician | — | — | — |

## Other

- **Enumeration date:** 03/11/2020
- **Last updated:** 03/11/2020