Provider Demographics
NPI:1194112771
Name:FLINT ODYSSEY HOUSE, INC.
Entity type:Organization
Organization Name:FLINT ODYSSEY HOUSE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:MEG
Authorized Official - Last Name:SHEWMAKER
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW, CAADC, CCDP-D,
Authorized Official - Phone:810-238-7226
Mailing Address - Street 1:529 MARTIN LUTHER KING JR AVE
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48502
Mailing Address - Country:US
Mailing Address - Phone:810-238-7226
Mailing Address - Fax:
Practice Address - Street 1:1431 LAPEER AVE
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-4277
Practice Address - Country:US
Practice Address - Phone:810-238-7226
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-21
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISA0250303251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health