Jacy1 Dba Anchorage
Substance Abuse Rehabilitation Facility in Moorhead, MN. Organization (NPI-2).
NPI number1508044975
StatusActive
Last updated in NPPESFeb 7, 2008
Details
- NPI
- 1508044975
- Entity type
- Organization (NPI-2)
- Legal business name
- Jacy1 Dba Anchorage
- Organization subpart
- No
- Enumeration date
- Feb 7, 2008
- Last updated
- Feb 7, 2008
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 324500000X | Substance Abuse Rehabilitation Facility | 1044799 | MN | Yes |
Practice location
810 4th St SSuite 152
Moorhead, MN 56560
Phone 218-287-1500 · Fax 218-287-1267
Mailing address
810 4th St SSuite 152
Moorhead, MN 56560
Phone 218-287-1500 · Fax 218-287-1267
Authorized official
Laurie Joanne Ray
Program Director
2182871500
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