Basic Information
| Provider Information | |||||||||
| NPI: | 1497986483 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FLINT ODYSSEY HOUSE, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 529 M L KING AVE | ||||||||
| Address2: | |||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485022002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8102387226 | ||||||||
| FaxNumber: | 8102395518 | ||||||||
| Practice Location | |||||||||
| Address1: | 1108 LAPEER RD | ||||||||
| Address2: | |||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485032704 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8102385888 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/07/2009 | ||||||||
| LastUpdateDate: | 10/20/2021 | ||||||||
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| AuthorizedOfficialLastName: | SHEWMAKER | ||||||||
| AuthorizedOfficialFirstName: | KIMBERLY | ||||||||
| AuthorizedOfficialMiddleName: | MEG | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATIVEDIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8102387226 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | LMSW, CAAC, CCS-M | ||||||||
| NPICertificationDate: | 10/20/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | 250349 | MI | Y | Agencies | Community/Behavioral Health |
No ID Information.