Jacy 2, LLC

Primary specialty

Children's Substance Abuse Rehabilitation FacilityTaxonomy code 3245S0500X

License

1047343 Issued in MN

Legal business name

JACY 2, LLC

Practice address

319 Csah #20
Litchfield, MN 55355

Phone

(320) 255-9530

NPI assigned

Sep 5, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Carmen Marie Wilson

Title

Owner

Phone

(320) 255-9530

Specialties & licenses 1

Addresses

Other names 1

• Wings Doing business as

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Del Sand

  • Psychologist
  • Lake Elmo, MN
  • NPI 1447410121
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1188950400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1188950400000",
    "number": "1124212873",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1096 E 260TH ST",
            "city": "NEW PRAGUE",
            "state": "MN",
            "postal_code": "560718880",
            "telephone_number": "320-255-9530"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "319 CSAH #20",
            "city": "LITCHFIELD",
            "state": "MN",
            "postal_code": "55355",
            "telephone_number": "320-255-9530"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACY 2, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-05",
        "last_updated": "2007-09-05",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "CARMEN",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "320-255-9530"
    },
    "taxonomies": [
        {
            "code": "3245S0500X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children",
            "state": "MN",
            "license": "1047343",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wings",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Children's Substance Abuse Rehabilitation Facility in Litchfield, MN
• Providers in Litchfield, MN by specialty
• Children's Substance Abuse Rehabilitation Facility in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.