Organization
ODYSSEY HOUSE INC
Active
Other names
Odyssey House Martindale Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
ADAM COHEN (CEO)
(801) 428-3449
Entity
Organization
Contact information
Practice address
743 E 300 S, SALT LAKE CITY, UT 84102
(801) 428-3500
(801) 210-5031
Mailing address
344 E 100 S STE 301, SALT LAKE CITY, UT 84111-1727
(801) 322-4257
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207QA0401X
Addiction Medicine (Family Medicine) Physician
—
—
Other
Enumeration date
03/11/2020
Last updated
03/11/2020
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