Provider Demographics
NPI:1083369235
Name:DRAGONFLY CHILDRENS RESPITE
Entity Type:Organization
Organization Name:DRAGONFLY CHILDRENS RESPITE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JALCYN
Authorized Official - Middle Name:A
Authorized Official - Last Name:LANGNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-457-2074
Mailing Address - Street 1:46232 ST LAWRENCE DR
Mailing Address - Street 2:
Mailing Address - City:PERHAM
Mailing Address - State:MN
Mailing Address - Zip Code:56573-8837
Mailing Address - Country:US
Mailing Address - Phone:218-457-2074
Mailing Address - Fax:
Practice Address - Street 1:501 2ND AVE NW
Practice Address - Street 2:
Practice Address - City:NEW PRAGUE
Practice Address - State:MN
Practice Address - Zip Code:56071-1415
Practice Address - Country:US
Practice Address - Phone:218-457-2074
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-16
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child