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Organization

JESSICA LANE RE, LLC

Active
Other names
The Recovery Village Kansas City, The Recovery Village Kansas City Outpatient Center
Organization subpart
No

Provider details

NPI number
Authorized official
BELINA SURUJON (VP CONTRACTING & LICENSING)
(305) 785-5520
Entity
Organization

Contact information

Practice address
305 NW ENGLEWOOD CT STE 300, GLADSTONE, MO 64118-4000
(754) 300-3120
(888) 919-4431
Mailing address
100 SE 3RD AVE STE 1800, FORT LAUDERDALE, FL 33394-0011
(754) 300-3120

Taxonomy

Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
324500000X
Substance Abuse Rehabilitation Facility
Primary

Other

Enumeration date
01/24/2025
Last updated
01/24/2025
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