Provider Demographics
NPI:1619091659
Name:ODYSSEY PROGRAMS, LLC
Entity Type:Organization
Organization Name:ODYSSEY PROGRAMS, LLC
Other - Org Name:ODYSSEY - DAKOTA COUNTY JUVENILE SERVICE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR - REVENUE CYCLE MANAGEMENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:LINDEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-326-7566
Mailing Address - Street 1:550 MAIN STR
Mailing Address - Street 2:#230
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:MN
Mailing Address - Zip Code:55112
Mailing Address - Country:US
Mailing Address - Phone:612-326-7600
Mailing Address - Fax:612-326-7549
Practice Address - Street 1:1600 HIGHWAY 55
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:MN
Practice Address - Zip Code:55003
Practice Address - Country:US
Practice Address - Phone:651-438-8219
Practice Address - Fax:651-438-8252
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MERIDIAN BEHAVIORAL HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-16
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1023927101YA0400X
MN10239271CDT324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty