Organization
JESSICA LANE RE, LLC
Active
Organization
JESSICA LANE RE, LLC
Active
Other names
The Recovery Village Kansas City
Organization subpart
No
Provider details
NPI number
Authorized official
BELINA SURUJON (CONTRACTING & LICENSING DIRECTOR)
(305) 785-5520
Entity
Organization
Contact information
Practice address
11901 JESSICA LN, RAYTOWN, MO 64138-2639
(754) 300-3120
(888) 919-4431
Mailing address
2200 N COMMERCE PKWY STE 200, WESTON, FL 33326-3258
(305) 785-5520
(888) 919-4431
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
323P00000X
Psychiatric Residential Treatment Facility
—
—
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
01/16/2023
Last updated
05/11/2026
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