NPIMap

Organization Active NPI

Odyssey House, Inc.

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Hampton, NH
National Provider Identifier
1295936730
Registry record updated Oct 23, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X
License
1071 Issued in NH
Legal business name
ODYSSEY HOUSE, INC.
Doing business as
OdysseyNH
Practice address
30 Winnacunnet Rd
Hampton, NH 03842-2121
Phone
(603) 758-1550
Fax
(603) 758-1522
NPI assigned
May 31, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 23, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Erik B. Johannessen, LICSW
Title
Ceo
Phone
(603) 758-1590

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X 1071 NH Primary

Addresses

Primary practice location

30 Winnacunnet Rd
Hampton, NH 03842-2121

Mailing address

30 Winnacunnet Rd
P.O. Box 479
Hampton, NH 03842-2121
Phone (603) 758-1550

Other identifiers 1

IdentifierTypeStateIssuer
30007079MedicaidNH

Other names 1

  • OdysseyNH Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Odyssey House Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1180569600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1224720000000",
    "number": "1295936730",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 WINNACUNNET RD",
            "address_2": "P.O. BOX 479",
            "city": "HAMPTON",
            "state": "NH",
            "postal_code": "038422121",
            "telephone_number": "603-758-1550",
            "fax_number": "603-758-1522"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 WINNACUNNET RD",
            "city": "HAMPTON",
            "state": "NH",
            "postal_code": "038422121",
            "telephone_number": "603-758-1550",
            "fax_number": "603-758-1522"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ODYSSEY HOUSE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-31",
        "last_updated": "2008-10-23",
        "status": "A",
        "authorized_official_last_name": "JOHANNESSEN",
        "authorized_official_first_name": "ERIK",
        "authorized_official_middle_name": "B.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "603-758-1590",
        "authorized_official_credential": "LICSW"
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "NH",
            "license": "1071",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30007079",
            "state": "NH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "OdysseyNH",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hampton, NH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.