Organization
JACY 2, LLC
Active
Organization
JACY 2, LLC
Active
Other names
Wings
Organization subpart
No
Provider details
NPI number
Authorized official
CARMEN MARIE WILSON (OWNER)
(320) 255-9530
Entity
Organization
Contact information
Practice address
319 CSAH #20, LITCHFIELD, MN 55355
(320) 255-9530
Mailing address
1096 E 260TH ST, NEW PRAGUE, MN 56071-8880
(320) 255-9530
Taxonomy
Speciality
Code
Description
License number
State
3245S0500X
Children's Substance Abuse Rehabilitation Facility
Primary
1047343
MN
Other
Enumeration date
09/05/2007
Last updated
09/05/2007
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