Organization
NELLY CARE CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHANIE L JARGBAH (PRESIDENT)
(612) 242-5770
Entity
Organization
Contact information
Practice address
6412 JUNE AVE N, BROOKLYN CENTER, MN 55429-2127
(612) 552-1090
Mailing address
6412 JUNE AVE N, BROOKLYN CENTER, MN 55429-2127
(612) 552-1090
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
—
—
3245S0500X
Children's Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
12/09/2024
Last updated
12/09/2024
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