Nelly Care Center LLC

Primary specialty

Children's Substance Abuse Rehabilitation FacilityTaxonomy code 3245S0500X

Legal business name

NELLY CARE CENTER LLC

Practice address

6412 June Ave N
Brooklyn Center, MN 55429-2127

Phone

(612) 552-1090

NPI assigned

Dec 9, 2024

Organization subpart

No

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

Authorized official

Name

Stephanie L Jargbah

Title

President

Phone

(612) 242-5770

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1733702400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733702400000",
    "number": "1316753908",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6412 JUNE AVE N",
            "city": "BROOKLYN CENTER",
            "state": "MN",
            "postal_code": "554292127",
            "telephone_number": "612-552-1090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6412 JUNE AVE N",
            "city": "BROOKLYN CENTER",
            "state": "MN",
            "postal_code": "554292127",
            "telephone_number": "612-552-1090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NELLY CARE CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-12-09",
        "last_updated": "2024-12-09",
        "certification_date": "2024-12-08",
        "status": "A",
        "authorized_official_last_name": "JARGBAH",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "612-242-5770"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3245S0500X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tanner Jacob Nayes
• Jenerose Ndayisenga
• Gladys Ndip
• Hanna Nedrud, MD
• Lauren Olivia Neitzke, DDS
• Bradley Eugene Nelson, CNP
• David Jack Nelson
• Jamar Bernard Nelson
• Tanisha Nelson
• New Directions for Change

• Children's Substance Abuse Rehabilitation Facility in Brooklyn Center, MN
• Providers in Brooklyn Center, 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 Dec 9, 2024; 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.