Jasob Supported Living, LLC

Primary specialty

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

Legal business name

JASOB SUPPORTED LIVING, LLC

Practice address

10436 Southerwick PL
Johnston, IA 50131-2560

Phone

(515) 745-4982

NPI assigned

Jan 9, 2024

Last updated

Jan 9, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Barituka Ade

Title

Owner

Phone

(515) 745-4982

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1704758400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704758400000",
    "number": "1467223552",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8805 CHAMBERY BLVD STE 300",
            "city": "JOHNSTON",
            "state": "IA",
            "postal_code": "501318816"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10436 SOUTHERWICK PL",
            "city": "JOHNSTON",
            "state": "IA",
            "postal_code": "501312560",
            "telephone_number": "515-745-4982"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JASOB SUPPORTED LIVING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-01-09",
        "last_updated": "2024-01-09",
        "certification_date": "2024-01-09",
        "status": "A",
        "authorized_official_last_name": "ADE",
        "authorized_official_first_name": "BARITUKA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "515-745-4982"
    },
    "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": []
}

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• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Johnston, IA
• Providers in Johnston, IA by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2024; 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.