MEDICARE: ASSOCIATION FOR RETARDED CITIZENS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	347C00000X	Private Vehicle	F002	FL
2	385HR2060X	Child Intellectual and/or Developmental Disabilities Respite Care	F002	FL
3	253Z00000X	In Home Supportive Care Agency	F002	FL
4	251C00000X	Developmentally Disabled Services Day Training Agency	251C00000X	FL
5	251C00000X	Developmentally Disabled Services Day Training Agency	F002	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	098929196	OTHER	FL	PROVIDER ID

General Provider Information

NPI Number	:	1487630729
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASSOCIATION FOR RETARDED CITIZENS

Provider Business Mailing Address
First Line	:	86051 HAMILTON ST
Second Line	:
City	:	YULEE
State	:	FL
Zip	:	32097-2711
Country	:	US
Telephone Number	:	904-225-9355
Fax Number	:	904-225-9262

Provider Business Practice Location Address
First Line	:	86051 HAMILTON ST
Second Line	:
City	:	YULEE
State	:	FL
Zip	:	32097-2711
Country	:	US
Telephone Number	:	904-225-9355
Fax Number	:	904-225-9262

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MS. FAY JOHNSON
Credential	:
Telephone Number	:	904-225-9355

Provider Enumeration Date	:	12/19/2005
Last Update Date	:	07/21/2022

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Directions to “ASSOCIATION FOR RETARDED CITIZENS ” Practice Location

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