Provider Demographics
NPI:1780972026
Name:ODYSSEY ADULT DAY SERVICES
Entity type:Organization
Organization Name:ODYSSEY ADULT DAY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DELYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-831-1090
Mailing Address - Street 1:1304 CLAY ST
Mailing Address - Street 2:
Mailing Address - City:VICKSBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39183-3012
Mailing Address - Country:US
Mailing Address - Phone:601-831-1090
Mailing Address - Fax:
Practice Address - Street 1:1304 CLAY ST
Practice Address - Street 2:
Practice Address - City:VICKSBURG
Practice Address - State:MS
Practice Address - Zip Code:39183-3012
Practice Address - Country:US
Practice Address - Phone:601-831-1090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-20
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No302R00000XManaged Care OrganizationsHealth Maintenance Organization