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Organization
THE JODY HOUSE ISL COMPANY LLC
Active
Organization
THE JODY HOUSE ISL COMPANY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHAD ROBERT LEWIS (DIRECTOR)
(573) 465-3654
Entity
Organization
Contact information
Practice address
407 E 6TH ST, ROLLA, MO 65401-3368
(573) 465-3654
(888) 858-8055
Mailing address
407 E 6TH ST, ROLLA, MO 65401-3368
(573) 465-3654
(888) 858-8055
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
NULL
Other
Enumeration date
03/02/2009
Last updated
03/02/2009
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