Healthcare Provider Details

I. General information

NPI: 1699597880
Provider Name (Legal Business Name): THE ARC OF THE ST JOHNS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2024
Last Update Date: 10/29/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 ARC DRIVE
ST. AUGUSTINE FL
32084
US

IV. Provider business mailing address

2101 ARC DR
ST AUGUSTINE FL
32084-0512
US

V. Phone/Fax

Practice location:
  • Phone: 904-824-7249
  • Fax:
Mailing address:
  • Phone: 904-824-7249
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JUSTIN BREIDENSTEIN
Title or Position: CFO
Credential:
Phone: 904-824-7249