=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831054295
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DRAGONFLY CHILDREN'S RESPITE HOME INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/18/2025
-----------------------------------------------------
Last Update Date | 12/18/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 145 E 66TH ST
-----------------------------------------------------
City | RICHFIELD
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55423-2457
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 218-457-2074
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 145 E 66TH ST
-----------------------------------------------------
City | RICHFIELD
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55423-2457
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 218-457-2074
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JACLYN LANGNER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 218-457-2074
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------