Jessica Lane Re, LLC

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

Legal business name

JESSICA LANE RE, LLC

Practice address

11901 Jessica LN
Raytown, MO 64138-2639

Phone

(754) 300-3120

Fax

(888) 919-4431

NPI assigned

Jan 16, 2023

Organization subpart

No

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

Authorized official

Name

Belina Surujon

Title

Contracting & Licensing Director

Phone

(305) 785-5520

Specialties & licenses 3

Addresses

Other names 1

• The Recovery Village Kansas City Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Tax ID family

Jessica Lane Re LLC2 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.

• Jessica Lane Re, LLC

  • Substance Abuse Rehabilitation Facility
  • Gladstone, MO
  • NPI 1023820073
  NPD tax ID

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

{
    "created_epoch": "1673827200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1778457600000",
    "number": "1760197644",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2200 N COMMERCE PKWY STE 200",
            "city": "WESTON",
            "state": "FL",
            "postal_code": "333263258",
            "telephone_number": "305-785-5520",
            "fax_number": "888-919-4431"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11901 JESSICA LN",
            "city": "RAYTOWN",
            "state": "MO",
            "postal_code": "641382639",
            "telephone_number": "754-300-3120",
            "fax_number": "888-919-4431"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "305 NW Englewood Ct Ste 300",
            "address_purpose": "LOCATION",
            "city": "Gladstone",
            "state": "MO",
            "postal_code": "641184000",
            "country_code": "US",
            "telephone_number": "305-785-5520",
            "fax_number": "888-919-4431",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "JESSICA LANE RE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-01-16",
        "last_updated": "2026-05-11",
        "certification_date": "2026-05-11",
        "status": "A",
        "authorized_official_last_name": "SURUJON",
        "authorized_official_first_name": "BELINA",
        "authorized_official_title_or_position": "CONTRACTING & LICENSING DIRECTOR",
        "authorized_official_telephone_number": "305-785-5520"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "323P00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Residential Treatment Facility",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Recovery Village Kansas City",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "The Recovery Village Kansas City",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Anne Elizabeth Isinger, DDS
• Rose Iyewarun, PHD
• Donica Chivon Jackson, CPTA
• Rubelita James, DDS
• Jeffrey L. Nixon L.L.C.
• Callie Rae Johnson
• Dorothy V Johnson, RNC,MSN,ANP
• Laura E Johnson
• Neisha Johnson, NURSE, HEALTH CARE P
• Rachel Marie Johnson, MSN

• Substance Abuse Rehabilitation Facility in Raytown, MO
• Providers in Raytown, MO by specialty
• Substance Abuse Rehabilitation Facility in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.