National Provider Identifier Database

JACY1 DBA ANCHORAGE
Substance Abuse Disorder Rehabilitation Facility

A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances.


Contact Information

JACY1 DBA ANCHORAGE
810 4TH ST S
SUITE 152
MOORHEAD, MN56560
Phone: 218-287-1500
Fax: 218-287-1267
Website:
Specialty Taxonomy Code
* Substance Abuse Disorder Rehabilitation Facility 324500000X

* Indicates primary specialty

NPI Profile & details for JACY1 DBA ANCHORAGE

NPI Number 1508044975
Legal business name
LBN
JACY1 DBA ANCHORAGE
Authorized official LAURIE RAY - (PROGRAM DIRECTOR)
Entity Organization
Organization subpart No
Enumeration date 02/07/2008
Last updated 02/07/2008 - About 18 years ago
Sole proprietor1 Not specified
Identifiers
  • MN License #: 1044799

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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