Organization
JODY HOUSE LLC
Active
Other names
visions isl
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. RUTH LEE RUCK (OWNER)
(573) 578-2979
Entity
Organization
Contact information
Practice address
602 NORTH WALNUT, 2608 BROOK, ROLLA, MO 65401
(573) 578-2979
(572) 364-4778
Mailing address
407 E 6TH ST, ROLLA, MO 65401-3368
(573) 578-2979
(573) 364-4778
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
265068694
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
856095401
—
MO
Enumeration date
03/20/2007
Last updated
07/29/2008
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