Healthcare Provider Details

I. General information

NPI: 1023082849
Provider Name (Legal Business Name): ST. ANDREW BAY CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2006
Last Update Date: 05/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1804 CAROLINA AVE 1804 CAROLINA AVENUE
LYNN HAVEN FL
32444-4256
US

IV. Provider business mailing address

1804 CAROLINA AVE 1804 CAROLINA AVENUE
LYNN HAVEN FL
32444-4256
US

V. Phone/Fax

Practice location:
  • Phone: 850-265-2951
  • Fax: 850-248-2952
Mailing address:
  • Phone: 850-265-2951
  • Fax: 850-248-2952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number501(C)3
License Number StateFL

VIII. Authorized Official

Name: MS. CATHY MILLER HOWELL
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 850-265-2951