Provider Demographics
NPI:1639824634
Name:BAY CITY ODYSSEY HOUSE, INC.
Entity Type:Organization
Organization Name:BAY CITY 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:810-238-7226
Mailing Address - Fax:810-239-5518
Practice Address - Street 1:1005 3RD ST
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48708-6012
Practice Address - Country:US
Practice Address - Phone:810-238-7226
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FLINT ODYSSEY HOUSE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-02-17
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health