Healthcare Provider Details

I. General information

NPI: 1275144248
Provider Name (Legal Business Name): ST. AUGUSTINE HEALTH SYSTEM INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2020
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3104 LORD BALTIMORE DR STE 105
WINDSOR MILL MD
21244-5801
US

IV. Provider business mailing address

3104 LORD BALTIMORE DR STE 105
WINDSOR MILL MD
21244-5801
US

V. Phone/Fax

Practice location:
  • Phone: 410-725-2324
  • Fax:
Mailing address:
  • Phone: 410-725-2324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name: AUGUSTINE JACOBSON
Title or Position: CEO
Credential:
Phone: 410-725-2324