Provider Demographics
NPI:1871114413
Name:ODYSSEY MENTAL HEALTH AND ADDICTION CENTER, LLC
Entity type:Organization
Organization Name:ODYSSEY MENTAL HEALTH AND ADDICTION CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:SILAO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-597-0082
Mailing Address - Street 1:35 JOURNAL SQ STE 629D
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-4029
Mailing Address - Country:US
Mailing Address - Phone:800-673-5766
Mailing Address - Fax:201-653-0917
Practice Address - Street 1:35 JOURNAL SQ STE 629D
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-4029
Practice Address - Country:US
Practice Address - Phone:800-673-5766
Practice Address - Fax:201-653-0917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-06
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health