Healthcare Provider Details

I. General information

NPI: 1811893258
Provider Name (Legal Business Name): QSH ST AUGUSTINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2026
Last Update Date: 10/14/2026
Certification Date: 10/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 VILLAGE CROSSING CT
ST AUGUSTINE FL
32084-8697
US

IV. Provider business mailing address

8465 KEYSTONE XING STE 120
INDIANAPOLIS IN
46240-4355
US

V. Phone/Fax

Practice location:
  • Phone: 904-617-0500
  • Fax: 904-617-0501
Mailing address:
  • Phone: 904-617-0500
  • Fax: 904-617-0501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number
License Number State

VIII. Authorized Official

Name: MORRIS D LONG
Title or Position: CEO
Credential:
Phone: 574-339-3021