Provider Demographics
NPI:1629884986
Name:FLINT ODYSSEY HOUSE, INC. - OUTPATIENT SERVICES
Entity type:Organization
Organization Name:FLINT ODYSSEY HOUSE, INC. - OUTPATIENT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROCHELL
Authorized Official - Middle Name:
Authorized Official - Last Name:HARPER-SHELTON
Authorized Official - Suffix:
Authorized Official - Credentials:MSA, CADC
Authorized Official - Phone:810-449-4038
Mailing Address - Street 1:1116 W BRISTOL RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-5518
Mailing Address - Country:US
Mailing Address - Phone:810-238-7226
Mailing Address - Fax:810-239-5518
Practice Address - Street 1:1116 W BRISTOL RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-5518
Practice Address - Country:US
Practice Address - Phone:810-238-7226
Practice Address - Fax:810-239-5518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-10
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility