Provider Demographics
NPI:1366060584
Name:RURAL BEHAVIORAL HEALTH, LLC
Entity type:Organization
Organization Name:RURAL BEHAVIORAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:JOLLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-596-1949
Mailing Address - Street 1:2212 IRONWOOD CT
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50014-7872
Mailing Address - Country:US
Mailing Address - Phone:423-596-1949
Mailing Address - Fax:515-450-5323
Practice Address - Street 1:2212 IRONWOOD CT
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50014-7872
Practice Address - Country:US
Practice Address - Phone:423-596-1949
Practice Address - Fax:515-450-5323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-14
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty