MEDICARE: FLINT ODYSSEY HOUSE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1194395566
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLINT ODYSSEY HOUSE, INC.

Provider Business Mailing Address
First Line	:	529 MARTIN LUTHER KING JUNIOR BLVD
Second Line	:
City	:	FLINT
State	:	MI
Zip	:	48502-2002
Country	:	US
Telephone Number	:	810-238-5888
Fax Number	:

Provider Business Practice Location Address
First Line	:	1303 MARTIN LUTHER KING AVE
Second Line	:
City	:	FLINT
State	:	MI
Zip	:	48503-1447
Country	:	US
Telephone Number	:	810-238-5888
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE COORDINATOR
Name	:	ROCHELL DENELL HARPER-SHELTON
Credential	:	MSA
Telephone Number	:	810-238-7226

Provider Enumeration Date	:	06/29/2021
Last Update Date	:	06/29/2021

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Directions to “FLINT ODYSSEY HOUSE, INC. ” Practice Location

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