Provider Demographics
NPI:1497986483
Name:FLINT ODYSSEY HOUSE, INC.
Entity Type:Organization
Organization Name:FLINT ODYSSEY HOUSE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVEDIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:MEG
Authorized Official - Last Name:SHEWMAKER
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW, CAAC, CCS-M
Authorized Official - Phone:810-238-7226
Mailing Address - Street 1:529 M L KING AVE
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:810-238-7226
Mailing Address - Fax:810-239-5518
Practice Address - Street 1:1108 LAPEER RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503-2704
Practice Address - Country:US
Practice Address - Phone:810-238-5888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-07
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI250349251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health