Provider Demographics
NPI:1679051759
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 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:810-238-5518
Practice Address - Street 1:718 GRISWOLD ST
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-5847
Practice Address - Country:US
Practice Address - Phone:810-937-5366
Practice Address - Fax:810-937-5172
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FLINT ODYSSEY HOUSE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-08-01
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility