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Organization

JACY1 DBA ANCHORAGE

Active
Organization subpart
No

Provider details

NPI number
Authorized official
LAURIE JOANNE RAY LAC (PROGRAM DIRECTOR)
(218) 287-1500
Entity
Organization

Contact information

Practice address
810 4TH ST S, SUITE 152, MOORHEAD, MN 56560
(218) 287-1500
(218) 287-1267
Mailing address
810 4TH ST S, SUITE 152, MOORHEAD, MN 56560
(218) 287-1500
(218) 287-1267

Taxonomy

Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
1044799
MN

Other

Enumeration date
02/07/2008
Last updated
02/07/2008
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