Provider Demographics
NPI:1649455387
Name:ODYSSEY ADULT DAYCARE
Entity type:Organization
Organization Name:ODYSSEY ADULT DAYCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DIMITRA
Authorized Official - Middle Name:A
Authorized Official - Last Name:KELLUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-370-2200
Mailing Address - Street 1:18303 STRACK DR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-8140
Mailing Address - Country:US
Mailing Address - Phone:281-370-2200
Mailing Address - Fax:
Practice Address - Street 1:18303 STRACK DR
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-8140
Practice Address - Country:US
Practice Address - Phone:281-370-2200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-31
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
No385H00000XRespite Care FacilityRespite Care
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)