Organization
JACY, LLC
Active
Other names
Stoneridge
Organization subpart
No
Provider details
NPI number
Authorized official
CARMEN MARIE WILSON (OWNER)
(320) 255-9530
Entity
Organization
Contact information
Practice address
616 EMMAS DR SE, COLD SPRING, MN 56320-1454
(320) 685-4578
Mailing address
600 25TH AVE S, STE 201, SAINT CLOUD, MN 56301-4841
(320) 255-9530
(320) 251-2996
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
1043554-2-AFC
MN
Other
Enumeration date
05/04/2007
Last updated
08/22/2020
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