Whalio Doctors

NPI 1265751762

St Johns Youth Academy

Organisation Emotionally Disturbed Childrens' Residential Treatment Facility St Augustine, FL

Practice location

Address
4500 Avenue D, St Augustine, FL 32095-5245
Phone
(904) 829-8850
Fax
(904) 829-8851

Authorised official

Name
Barika Grayson
Title
Clinical Director
Phone
(904) 829-8850

Registered specialties (2)

Emotionally Disturbed Childrens' Residential Treatment Facility Primary
Residential Treatment Facilities Taxonomy 322D00000X
Children's Substance Abuse Rehabilitation Facility
Residential Treatment Facilities Taxonomy 3245S0500X Licence 0755AD5690-09 (FL)

Registry record

NPI
1265751762
Entity type
Organization
NPI issued
24 May 2010
Record last updated
24 May 2010

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.