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General NPI Number Information
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NPI Number | 1699597880
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Entity Type | Organization
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Legal Business Name | THE ARC OF THE ST JOHNS
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Dates
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Enumeration Date | 10/29/2024
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Last Update Date | 10/29/2024
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Provider Practice Location Address
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Address Line | 2101 ARC DRIVE
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City | ST. AUGUSTINE
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State | FL
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Zip | 32084
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Country | US
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Telephone | 904-824-7249
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Fax |
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Provider Business Mailing Address
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Address Line | 2101 ARC DR
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City | ST AUGUSTINE
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State | FL
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Zip | 32084-0512
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Country | US
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Telephone | 904-824-7249
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | JUSTIN BREIDENSTEIN
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Credential |
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Telephone | 904-824-7249
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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