Provider Demographics
NPI:1639213176
Name:THE JODY HOUSE
Entity Type:Organization
Organization Name:THE JODY HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:RUCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-578-2979
Mailing Address - Street 1:407 E 6TH ST
Mailing Address - Street 2:
Mailing Address - City:ROLLA
Mailing Address - State:MO
Mailing Address - Zip Code:65401-3368
Mailing Address - Country:US
Mailing Address - Phone:573-578-2979
Mailing Address - Fax:
Practice Address - Street 1:603 N WALNUT ST
Practice Address - Street 2:
Practice Address - City:ROLLA
Practice Address - State:MO
Practice Address - Zip Code:65401-3356
Practice Address - Country:US
Practice Address - Phone:573-364-1589
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty