Healthcare Provider Details

I. General information

NPI: 1659949600
Provider Name (Legal Business Name): ARIANNA RENEE CELANO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2021
Last Update Date: 06/16/2021
Certification Date: 06/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 SIMONE WAY
ST AUGUSTINE FL
32086-7750
US

IV. Provider business mailing address

500 TUSCAN RESERVE DR UNIT 533
PALM COAST FL
32164-1823
US

V. Phone/Fax

Practice location:
  • Phone: 904-829-1770
  • Fax:
Mailing address:
  • Phone: 630-901-4865
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number029585003
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: