Healthcare Provider Details

I. General information

NPI: 1649455387
Provider Name (Legal Business Name): ODYSSEY ADULT DAYCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2007
Last Update Date: 12/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18303 STRACK DR
SPRING TX
77379-8140
US

IV. Provider business mailing address

18303 STRACK DR
SPRING TX
77379-8140
US

V. Phone/Fax

Practice location:
  • Phone: 281-370-2200
  • Fax:
Mailing address:
  • Phone: 281-370-2200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MS. DIMITRA A KELLUM
Title or Position: DIRECTOR
Credential:
Phone: 281-370-2200