Provider Demographics
NPI:1902502255
Name:JODES FOSTER FAMILY HOME
Entity Type:Organization
Organization Name:JODES FOSTER FAMILY HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINSTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DES
Authorized Official - Middle Name:DESESE
Authorized Official - Last Name:DES
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:734-709-3784
Mailing Address - Street 1:3242 GOLFSIDE RD
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-3720
Mailing Address - Country:US
Mailing Address - Phone:734-709-3784
Mailing Address - Fax:734-761-3936
Practice Address - Street 1:3242 GOLFSIDE RD
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-3720
Practice Address - Country:US
Practice Address - Phone:734-709-3784
Practice Address - Fax:734-761-3936
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JODES FOSTER FAMILY HOME
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-02-07
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency