Provider Demographics
NPI:1194395566
Name:FLINT ODYSSEY HOUSE, INC.
Entity Type:Organization
Organization Name:FLINT ODYSSEY HOUSE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:ROCHELL
Authorized Official - Middle Name:DENELL
Authorized Official - Last Name:HARPER-SHELTON
Authorized Official - Suffix:
Authorized Official - Credentials:MSA
Authorized Official - Phone:810-238-7226
Mailing Address - Street 1:529 MARTIN LUTHER KING JUNIOR BLVD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48502-2002
Mailing Address - Country:US
Mailing Address - Phone:810-238-5888
Mailing Address - Fax:
Practice Address - Street 1:1303 MARTIN LUTHER KING AVE
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503-1447
Practice Address - Country:US
Practice Address - Phone:810-238-5888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FLINT ODYSSEY HOUSE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-06-29
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health