NPIMap

Organization Active NPI

Jacy II LLC

Doing business as Wings

  • Children's Substance Abuse Rehabilitation Facility
  • Litchfield, MN
National Provider Identifier
1760929574
Registry record updated Jan 31, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Children's Substance Abuse Rehabilitation FacilityTaxonomy code 3245S0500X
License
010872752 Issued in MN
Legal business name
JACY II LLC
Doing business as
Wings
Practice address
1326 E Ripley St
Litchfield, MN 55355-4525
Phone
(320) 593-0440
Fax
(320) 593-0442
NPI assigned
Jan 31, 2017
Last updated
Jan 31, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 31, 2017

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

Authorized official

Name
Mattie J Maumgaratner
Title
Administrator
Phone
(320) 593-0440

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Children's Substance Abuse Rehabilitation Facility 3245S0500X 010872752 MN Primary

Addresses

Primary practice location

1326 E Ripley St
Litchfield, MN 55355-4525

Mailing address

1326 E Ripley St
Litchfield, MN 55355-4525
Phone (320) 593-0440

Other names 1

  • WINGS Doing business as

National Provider Directory

National Provider Directory

Locations

1326 E Ripley St
Litchfield, MN 55355
Phone 3205930440 ext. 20

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1485820800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1485820800000",
    "number": "1760929574",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1326 E RIPLEY ST",
            "city": "LITCHFIELD",
            "state": "MN",
            "postal_code": "553554525",
            "telephone_number": "320-593-0440",
            "fax_number": "320-593-0442"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1326 E RIPLEY ST",
            "city": "LITCHFIELD",
            "state": "MN",
            "postal_code": "553554525",
            "telephone_number": "320-593-0440",
            "fax_number": "320-593-0442"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACY II LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-31",
        "last_updated": "2017-01-31",
        "status": "A",
        "authorized_official_last_name": "MAUMGARATNER",
        "authorized_official_first_name": "MATTIE",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "320-593-0440"
    },
    "taxonomies": [
        {
            "code": "3245S0500X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children",
            "state": "MN",
            "license": "010872752",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WINGS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Litchfield, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2017; 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.