Jody House LLC

Primary specialty

Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X

License

265068694 Issued in MO

Legal business name

JODY HOUSE LLC

Practice address

602 North Walnut
2608 Brook
Rolla, MO 65401

Phone

(573) 578-2979

Fax

(572) 364-4778

NPI assigned

Mar 20, 2007

Organization subpart

No

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

Authorized official

Name

Mrs. Ruth Lee Ruck

Title

Owner

Phone

(573) 578-2979

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• visions isl Former legal business name

Tax ID family

Jody House LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• The Jody House

  • Contractor
  • Rolla, MO
  • NPI 1639213176
  NPD tax ID

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

{
    "created_epoch": "1174348800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1217289600000",
    "number": "1700901816",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "407 E 6TH ST",
            "city": "ROLLA",
            "state": "MO",
            "postal_code": "654013368",
            "telephone_number": "573-578-2979",
            "fax_number": "573-364-4778"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "602 NORTH WALNUT",
            "address_2": "2608 BROOK",
            "city": "ROLLA",
            "state": "MO",
            "postal_code": "65401",
            "telephone_number": "573-578-2979",
            "fax_number": "572-364-4778"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JODY HOUSE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-20",
        "last_updated": "2008-07-29",
        "status": "A",
        "authorized_official_last_name": "RUCK",
        "authorized_official_first_name": "RUTH LEE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "573-578-2979",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "MO",
            "license": "265068694",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "856095401",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "visions isl",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Joyce D. Jarvis, LCSW
• Jawed Mohammed-Bharwani
• Karen Sue Jiles, D.O.
• Jim Verhoff and Associates
• Jim Verhoff and Associates
• Christopher L Johnson, DPM
• Jessica L Johnson
• Kimberly D. Johnson, MD
• Amber Lea Johnston, PLPC
• Alisha Michelle Jones, FNP-C

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2008; 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.