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
100 SE 3RD AVE STE 1800, FT LAUDERDALE, FL 33394-0011
(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
08/14/2025
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