| Organization Name: | JACY 2, LLC |
| NPI Number: | 1124212873 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CARMEN MARIE WILSON (OWNER) |
| Mailing Address: | 319 Csah #20 Litchfield |
| State: | MN US |
| Postal Code: | 55355 |
| Phone Number: | 3202559530 |
| Fax Number: | |
| NPI Enumeration Date: | 09/05/2007 |
| NPI Last Update Date: | 09/05/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 3245S0500X |
| License Number: | 1047343 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Residential Treatment Facilities |
| Taxonomy Classification: | Substance Abuse Rehabilitation Facility |
| Taxonomy Specialization: | Substance Abuse Treatment, Children |
| Taxonomy Definition: | A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of children with disorders in the use of drugs, alcohol, and other substances. Medical and supportive counseling services and education services are included. |