Provider Demographics
NPI:1891451761
Name:OZARK RECOVERY HOUSING LLC
Entity Type:Organization
Organization Name:OZARK RECOVERY HOUSING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:C
Authorized Official - Last Name:JASDANWALA
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:760-908-1253
Mailing Address - Street 1:17781 HORNBEAN DR
Mailing Address - Street 2:
Mailing Address - City:WILDWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63005-4229
Mailing Address - Country:US
Mailing Address - Phone:760-908-1253
Mailing Address - Fax:
Practice Address - Street 1:340 BALES AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64124-1973
Practice Address - Country:US
Practice Address - Phone:760-908-1253
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-15
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No251J00000XAgenciesNursing Care
No251S00000XAgenciesCommunity/Behavioral Health
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service