Desmond Odom | Anchorage, AK • PECOS Search

Desmond Odom

Behavior Technician

Behavioral Health & Social Service Providers

4130 San Ernesto Ave, Anchorage, AK 99508-2875

(907) 729-5070 (907) 729-7408

PECOS Enrollment

Based on the most recent information from CMS, provider Desmond Odom does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records yesterday at 12:57 PM.

Profile Details

Provider ID
1164115291
Provider Type
Individual
Full Name
Odom, Desmond
Gender
Male

Sole Proprietor
No
Enumeration Date
6/2/2023
Last Updated
6/2/2023

Contact Information

Practice Location

4130 San Ernesto Ave, Anchorage, AK 99508-2875

Unlisted Fax

Mailing Location

7033 E Tudor Rd, Anchorage, AK 99507-1262

(907) 729-6353

Provider Taxonomies

Code	Description	License
Code 106S00000X Primary	Description Behavior Technician Behavioral Health & Social Service Providers	License Unlisted Issuer