Provider Demographics
NPI:1033381652
Name:JODI'S HEART INC.
Entity Type:Organization
Organization Name:JODI'S HEART INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOAN (JODI)
Authorized Official - Middle Name:H
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-673-1022
Mailing Address - Street 1:PO BOX 6002
Mailing Address - Street 2:1815 NORTH MAIN STREET
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-1402
Mailing Address - Country:US
Mailing Address - Phone:307-673-0540
Mailing Address - Fax:307-673-0718
Practice Address - Street 1:1815 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-2503
Practice Address - Country:US
Practice Address - Phone:307-673-0540
Practice Address - Fax:307-673-0718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-25
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services