The Jody House Isl Company LLC

NPI #1275773376 in Rolla, Missouri

Provider Information

NPI Number: 1275773376
Entity Type: Organization
Organization Name: The Jody House Isl Company LLC
Primary Specialty: Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Enumeration Date: Mar 2, 2009
Last Updated: Mar 2, 2009

Practice Location

Address: 407 E 6TH ST
City: Rolla
State: Missouri
ZIP Code: 65401-3368
Phone: (573) 465-3654

Authorized Official

Name: CHAD ROBERT LEWIS
Title: DIRECTOR
Phone: (573) 465-3654

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Residential Treatment Facility, Intellectual and/or Developmental Disabilities	320600000X	Primary

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