Organization
JACY II LLC
Active
Other names
WINGS
Organization subpart
No
Provider details
NPI number
Authorized official
MATTIE J MAUMGARATNER (ADMINISTRATOR)
(320) 593-0440
Entity
Organization
Contact information
Practice address
1326 E RIPLEY ST, LITCHFIELD, MN 55355-4525
(320) 593-0440
(320) 593-0442
Mailing address
1326 E RIPLEY ST, LITCHFIELD, MN 55355-4525
(320) 593-0440
(320) 593-0442
Taxonomy
Speciality
Code
Description
License number
State
3245S0500X
Children's Substance Abuse Rehabilitation Facility
Primary
010872752
MN
Other
Enumeration date
01/31/2017
Last updated
01/31/2017
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