Healthcare Provider Details

I. General information

NPI: 1780525386
Provider Name (Legal Business Name): JAYJAY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2026
Last Update Date: 04/06/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4643 36TH AVE S APT 303
FARGO ND
58104
US

IV. Provider business mailing address

3523 45TH ST S # 183
FARGO ND
58104-8962
US

V. Phone/Fax

Practice location:
  • Phone: 701-200-1571
  • Fax:
Mailing address:
  • Phone: 701-200-1571
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM DARUS SMITH
Title or Position: PROGRAM DIRECTOR
Credential: AAS, BAS-PM
Phone: 701-200-1571