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General NPI Number Information
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NPI Number | 1356582209
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Entity Type | Organization
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Legal Business Name | ODYSSEY TLC ADULT DAYCARE,INC.
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Dates
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Enumeration Date | 03/23/2009
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Last Update Date | 09/08/2021
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Provider Practice Location Address
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Address Line | 220 N VISTA DR
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City | HOUSTON
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State | TX
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Zip | 77073-5385
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Country | US
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Telephone | 281-787-1429
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Fax |
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Provider Business Mailing Address
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Address Line | 220 N VISTA DR
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City | HOUSTON
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State | TX
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Zip | 77073-5385
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Country | US
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Telephone | 281-787-1429
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Fax | 281-784-1010
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. DIMITRA ANN KELLUN
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Credential | LMSW
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Telephone | 281-787-1429
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number | 101804
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License Number State | TX
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