Jacy1 Dba Anchorage

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

License

1044799 Issued in MN

Legal business name

JACY1 DBA ANCHORAGE

Practice address

810 4TH St S
Suite 152
Moorhead, MN 56560

Phone

(218) 287-1500

Fax

(218) 287-1267

NPI assigned

Feb 7, 2008

Organization subpart

No

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

Authorized official

Name

Laurie Joanne Ray, LAC

Title

Program Director

Phone

(218) 287-1500

Specialties & licenses 1

Addresses

Tax ID family

Anchorage2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Jacy 1

  • Substance Abuse Rehabilitation Facility
  • Saint Cloud, MN
  • NPI 1982879912
  NPD tax ID

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

{
    "created_epoch": "1202342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1202342400000",
    "number": "1508044975",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "810 4TH ST S",
            "address_2": "SUITE 152",
            "city": "MOORHEAD",
            "state": "MN",
            "postal_code": "56560",
            "telephone_number": "218-287-1500",
            "fax_number": "218-287-1267"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "810 4TH ST S",
            "address_2": "SUITE 152",
            "city": "MOORHEAD",
            "state": "MN",
            "postal_code": "56560",
            "telephone_number": "218-287-1500",
            "fax_number": "218-287-1267"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACY1 DBA ANCHORAGE",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-07",
        "last_updated": "2008-02-07",
        "status": "A",
        "authorized_official_last_name": "RAY",
        "authorized_official_first_name": "LAURIE",
        "authorized_official_middle_name": "JOANNE",
        "authorized_official_title_or_position": "PROGRAM DIRECTOR",
        "authorized_official_telephone_number": "218-287-1500",
        "authorized_official_credential": "LAC"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "MN",
            "license": "1044799",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dek Mohamed Iydid
• Nicholas Jackson
• Kristina Jacobs
• Benjamin Jacobson
• Mykaela Jacobson
• Ayan Jama
• Justine M Jarmin, MS
• Malich Dawit Jarso
• JC Lotzer Chiropractic Inc
• Jeffrey C, Harvey D.D.S., SC.D., P.a.

• Substance Abuse Rehabilitation Facility in Moorhead, MN
• Providers in Moorhead, MN by specialty
• Substance Abuse Rehabilitation Facility in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2008; 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.