Healthcare Provider Details

I. General information

NPI: 1598949018
Provider Name (Legal Business Name): ST JOHNS CO COUNCIL ON AGING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2007
Last Update Date: 08/02/2023
Certification Date: 08/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 MARINE ST
ST AUGUSTINE FL
32084-5153
US

IV. Provider business mailing address

180 MARINE ST
ST AUGUSTINE FL
32084-5153
US

V. Phone/Fax

Practice location:
  • Phone: 904-209-3700
  • Fax: 904-209-3663
Mailing address:
  • Phone: 904-209-3700
  • Fax: 904-209-3663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number5857
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number9004
License Number StateFL

VIII. Authorized Official

Name: BECKY YANNI
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 904-209-3685