Provider Demographics
NPI:1790189520
Name:ODYSSEY COMMUNITY SERVICES INC
Entity Type:Organization
Organization Name:ODYSSEY COMMUNITY SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TYRONE
Authorized Official - Middle Name:JACKSON
Authorized Official - Last Name:MELVIN
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:757-438-5447
Mailing Address - Street 1:13389 WINDSONG WAY
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:VA
Mailing Address - Zip Code:23314-3483
Mailing Address - Country:US
Mailing Address - Phone:757-438-5447
Mailing Address - Fax:866-389-9886
Practice Address - Street 1:710 MOBJACK PL
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-1957
Practice Address - Country:US
Practice Address - Phone:757-438-5447
Practice Address - Fax:866-389-9886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-22
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health