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	324500000X	Substance Abuse Rehabilitation Facility	250303	MI

General Provider Information

NPI Number	:	1841325172
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLINT ODYSSEY HOUSE, INC.

Provider Business Mailing Address
First Line	:	1116 W BRISTOL RD
Second Line	:
City	:	FLINT
State	:	MI
Zip	:	48507-5518
Country	:	US
Telephone Number	:	810-238-7226
Fax Number	:	810-239-5518

Provider Business Practice Location Address
First Line	:	529 MARTIN LUTHER KING BLVD
Second Line	:
City	:	FLINT
State	:	MI
Zip	:	48502-2002
Country	:	US
Telephone Number	:	810-238-7226
Fax Number	:	810-239-5518

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. RONALD SAHARA BROWN
Credential	:	CADC
Telephone Number	:	810-238-7226

Provider Enumeration Date	:	02/23/2007
Last Update Date	:	12/10/2024

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