Healthcare Provider Details

I. General information

NPI: 1407651276
Provider Name (Legal Business Name): THE ARC OF THE ST. JOHNS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2025
Last Update Date: 02/17/2025
Certification Date: 02/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2109 ARC DR
ST AUGUSTINE FL
32084-0512
US

IV. Provider business mailing address

2101 ARC DR
SAINT AUGUSTINE FL
32084-0512
US

V. Phone/Fax

Practice location:
  • Phone: 904-824-7249
  • Fax:
Mailing address:
  • Phone: 904-824-7249
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number
License Number StateNULL
# 5
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateNULL
# 6
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name: JUSTIN BREIDENSTEIN
Title or Position: DIRECTOR OF FINANCE
Credential:
Phone: 904-824-7249