Healthcare Provider Details

I. General information

NPI: 1346100369
Provider Name (Legal Business Name): LIVING STONE OUTREACH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2025
Last Update Date: 11/12/2025
Certification Date: 11/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 WARBLER RD
ST AUGUSTINE FL
32086-6229
US

IV. Provider business mailing address

1012 CHEYENNE DR
SAINT AUGUSTINE FL
32086-5519
US

V. Phone/Fax

Practice location:
  • Phone: 904-417-8011
  • Fax:
Mailing address:
  • Phone: 904-789-0059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: ANNA JO CORSI
Title or Position: CEO
Credential:
Phone: 904-789-0059