JESSICA LANE RE LLC NPI 1760197644

NPI Information

  • NPI: 1760197644
  • Provider Name: JESSICA LANE RE, LLC
  • Classification: Substance Abuse Rehabilitation Facility - 324500000X
  • Entity Type: Organization
  • :
  • Address: 11901 JESSICA LN
    RAYTOWN, MO
    ZIP 64138
  • Phone: (754) 300-3120

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NPI Details

JESSICA LANE RE, LLC is a substance abuse rehabilitation facility in Raytown, MO. The provider is 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. JESSICA LANE RE, LLC NPI is 1760197644. The provider is registered as an organization entity type.
The provider .

The provider's business location address is:

11901 JESSICA LN
RAYTOWN, MO
ZIP 64138-639
Phone: (754) 300-3120
Fax: (888) 919-4431

The provider's authorized official is Belina Surujon .
The authorized official title is Contracting & Licensing Director and has the following contact phone number (305) 785-5520.

The enumeration date for this NPI number is 1/16/2023 and was last updated on 8/14/2025.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261QM0801XClinic/CenterMental Health (Including Community Mental Health Center)No
2323P00000XPsychiatric Residential Treatment FacilityNo
3324500000XSubstance Abuse Rehabilitation FacilityYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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