Ellendel Isl LLC

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

Legal business name

ELLENDEL ISL LLC

Doing business as

Ellendel ISL

Practice address

1108 E Patterson
Suite 9
Kirksville, MO 63501

Phone

(660) 627-4101

Fax

(660) 665-0185

NPI assigned

Apr 9, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Rhoda Ellen Tomich

Title

Owner/Manager

Phone

(660) 627-4101

Specialties & licenses 1

Addresses

Other names 1

• Ellendel ISL Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176076800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1669334400000",
    "number": "1235252826",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 S JAMISON",
            "city": "KIRKSVILLE",
            "state": "MO",
            "postal_code": "63501",
            "telephone_number": "660-627-4101",
            "fax_number": "660-665-0185"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1108 E PATTERSON",
            "address_2": "SUITE 9",
            "city": "KIRKSVILLE",
            "state": "MO",
            "postal_code": "63501",
            "telephone_number": "660-627-4101",
            "fax_number": "660-665-0185"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELLENDEL ISL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-09",
        "last_updated": "2022-11-25",
        "certification_date": "2022-11-25",
        "status": "A",
        "authorized_official_last_name": "TOMICH",
        "authorized_official_first_name": "RHODA",
        "authorized_official_middle_name": "ELLEN",
        "authorized_official_title_or_position": "OWNER/MANAGER",
        "authorized_official_telephone_number": "660-627-4101"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ellendel ISL",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Kirksville, MO
• Providers in Kirksville, MO by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.