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
—
—
Other
Enumeration date
03/02/2009
Last updated
03/02/2009
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