Healthcare Provider Details

I. General information

NPI: 1033258561
Provider Name (Legal Business Name): ADAMS ACRES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1735 STATE ROAD 16
ST AUGUSTINE FL
32084-0807
US

IV. Provider business mailing address

1735 STATE ROAD 16
ST AUGUSTINE FL
32084-0807
US

V. Phone/Fax

Practice location:
  • Phone: 904-824-4391
  • Fax: 904-826-3835
Mailing address:
  • Phone: 904-824-4391
  • Fax: 904-826-3835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number StateFL

VIII. Authorized Official

Name: MR. SHANE MORAN
Title or Position: ADMINISTRATOR
Credential:
Phone: 904-824-4391