Provider Demographics
NPI:1356582209
Name:ODYSSEY TLC ADULT DAYCARE,INC.
Entity type:Organization
Organization Name:ODYSSEY TLC ADULT DAYCARE,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DIMITRA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:KELLUN
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:281-787-1429
Mailing Address - Street 1:220 N VISTA DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77073-5385
Mailing Address - Country:US
Mailing Address - Phone:281-787-1429
Mailing Address - Fax:281-784-1010
Practice Address - Street 1:220 N VISTA DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77073-5385
Practice Address - Country:US
Practice Address - Phone:281-787-1429
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-23
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101804261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care