Healthcare Provider Details

I. General information

NPI: 1487630729
Provider Name (Legal Business Name): ASSOCIATION FOR RETARDED CITIZENS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

86051 HAMILTON ST
YULEE FL
32097-2711
US

IV. Provider business mailing address

86051 HAMILTON ST
YULEE FL
32097-2711
US

V. Phone/Fax

Practice location:
  • Phone: 904-225-9355
  • Fax: 904-225-9262
Mailing address:
  • Phone: 904-225-9355
  • Fax: 904-225-9262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License NumberF002
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License NumberF002
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License NumberF002
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number251C00000X
License Number StateFL
# 5
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License NumberF002
License Number StateFL

VIII. Authorized Official

Name: MS. FAY JOHNSON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 904-225-9355