Jacy II LLC
Organization Active NPI Children's Substance Abuse Rehabilitation Facility · Litchfield, MN
NPI 1760929574 · NPPES record last updated Jan 31, 2017
Key facts
- NPI
- 1760929574
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Children's Substance Abuse Rehabilitation Facility 3245S0500X
- License
- 010872752 (MN)
- Legal business name
- JACY II LLC
- Practice address
- 1326 E Ripley St
Litchfield, MN 55355-4525 - Phone
- (320) 593-0440
- Fax
- (320) 593-0442
- NPI assigned
- Jan 31, 2017
- Organization subpart
- No
Authorized official
- Name
- Mattie J Maumgaratner
- Title
- Administrator
- Phone
- (320) 593-0440
Practitioners 10
-
Wylie Boehmlehner, BA, LADC
-
Kailly Allyce Bonnett, MS LADC LPCC
-
Tamarah Lynn Gehlen, MA MFT LADC
-
Kimberly Moos, LADC
-
Jessica Nicole Morriss, LPCC, LADC
-
Heidi J Peterson, MSW, LGSW
-
David Edward Schlack, LADC
-
Leah Marie Weires, LPCC
National Provider Directory
Locations
1326 E Ripley St
Litchfield, MN 55355
Phone 3205930440 ext. 20
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Children's Substance Abuse Rehabilitation Facility | 3245S0500X | 010872752 | MN | Yes |
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
- WINGS
Other providers in Litchfield, MN
- Hutchinson Superstore Inc.
- Ind School Dist 465
- Invisible Wounds LLC
- Sheila Marie Iverson
- Jacy 2, LLC
- James D Haugo DDS PA
- Ann Marie Jensen
- Teresa Ellen Joens-Pautzke
- Abigail Taylor Johnson
- Daniel A Johnson
All providers in Litchfield, MN · Children's Substance Abuse Rehabilitation Facility in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 31, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.