ST JOHNS YOUTH ACADEMY (NPI# 1265751762) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1265751762 |
| Entity Type | Organization |
| Organization Name | ST JOHNS YOUTH ACADEMY |
| Other Organization Name | YOUTH SERVICES INTERNATIONAL, INC. |
| Practice Address |
4500 Avenue D St Augustine FL 32095-5245 |
| Practice Telephone | 9048298850 |
| Practice Fax Number | 9048298851 |
| Mailing Telephone | 9048298850 |
| Mailing Fax Number | 9048298851 |
| Enumeration Date | 2010-05-24 |
| Last Update Date | 2010-05-24 |
| Authorized Official Name | MS. BARIKA GRAYSON (CLINICAL DIRECTOR) |
| Authorized Official Telephone | 9048298850 |
| Authorized Official Credential | L.M.H.C. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 3245S0500X |
Substance Abuse Rehabilitation Facility Specialization: Substance Abuse Treatment, Children |
0755AD5690-09 | FL | Residential Treatment Facilities |
| Y | 322D00000X | Residential Treatment Facility, Emotionally Disturbed Children | Residential Treatment Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | SUBSTANCE ABUSE LICENSE | 0755AD5690-09 | 01 |
| Other Name | Type Code |
|---|---|
| Youth Services International, Inc. | Other Name - Individual/Organization |
| Street Address |
4500 AVENUE D |
| City | ST AUGUSTINE |
| State | FL |
| Zip Code | 32095-5245 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124299201 | Dental Health Group PC | Dentist | 159 Palencia Village Drive, Ste 109, St. Augustine, FL 32095 | 2008-03-18 |
| 1932259405 | Thomas E Stakem | Dentist | 7175-01 U.S. Highway 17 South, Green Cove Springs, FL 32095 | 2007-01-10 |
| 1942390265 | Antonia Fuller | Registered Nurse | 354 Paseo Reyes Drive, Saint Augustine, FL 32095 | 2006-10-15 |
| 1740223023 | First Choice Phcy Svcs LLC | Pharmacy | 110 Cumberland Dr #305, St Augustine, FL 32095 | 2006-06-14 |
| 1174029201 | Aba Connection, LLC | Early Intervention Provider Agency | 23 Sol Ct, St Augustine, FL 32095 | 2018-04-05 |
| 1457437584 | Stanley A Cohen | Psychiatry & Neurology | 354 Paseo Reyes Drive, St Augustine, FL 32095 | 2006-10-31 |
| 1548576150 | Vicki Glabb | Counselor | 260 Ash Breeze Cv, Saint Augustine, FL 32095-0045 | 2010-08-20 |
| 1245770742 | Linda Gillis | Nurse Practitioner | 143 Portada Dr, St Augustine, FL 32095-1634 | 2017-03-02 |
| 1659821767 | Margo Slovis | Physical Therapist | 244 Vale Dr, St Augustine, FL 32095-4832 | 2016-10-12 |
| 1851909360 | Mammography Partners LLC | Clinic/Center | 521 Costa Del Sol Dr, St Augustine, FL 32095-4868 | 2020-07-21 |
| Find all providers in zip 32095 | ||||
| Taxonomy Code | 322D00000X |
| Grouping | Residential Treatment Facilities |
| Classification | Residential Treatment Facility, Emotionally Disturbed Children |
| A provider facility or distinct part of the organization which renders an interdisciplinary program of mental health treatment to individuals under 21 years of age who have persistent dysfunction in major life areas. The dysfunction is of an extent and pervasiveness that requires a protected and highly structured therapeutic environment. These organizations, or distinct part of organizations, exclude those that provide acute psychiatric care, partial hospitalization, group living, therapeutic schooling, primary diagnosis substance abuse disorder treatment, or primary diagnosis mental retardation or developmental disability treatment. |
| Notes: Source: U.S. Department of Defense Regulation 6010.8-R, Chapter 6. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023417045 | Iest. Augustine Youth Services | Residential Treatment Facility, Emotionally Disturbed Children | 201 Simone Way, St Augustine, FL 32086-7750 | 2014-08-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831748706 | The National Center for Life and Liberty | Residential Treatment Facility, Emotionally Disturbed Children | 13702 Green Isle Ter, Clermont, FL 34711-8426 | 2019-09-04 |
| 1881177509 | Sailfuture | Residential Treatment Facility, Emotionally Disturbed Children | 2900 68th Ave S, St Petersburg, FL 33712-5525 | 2018-09-09 |
| 1760892111 | Loving Arms Outreach, Inc. | Residential Treatment Facility, Emotionally Disturbed Children | 608 Nw 15th Ave, Pompano Beach, FL 33069-2829 | 2014-05-06 |
| 1689016560 | Alternate Group Care, Inc | Residential Treatment Facility, Emotionally Disturbed Children | 20250 Sw 50th Pl, Southwest Ranches, FL 33332-1021 | 2013-07-22 |
| 1528304714 | Linda Newsome | Residential Treatment Facility, Emotionally Disturbed Children | 1454 Bent Oaks Blvd, Deland, FL 32724-8062 | 2012-12-17 |
| 1528327335 | G4s Youth Services LLC | Residential Treatment Facility, Emotionally Disturbed Children | 6302 Benjamin Rd Ste 400, Tampa, FL 33634-5116 | 2012-05-14 |
| 1003172073 | Esther's Group Home Corp. | Residential Treatment Facility, Emotionally Disturbed Children | 20115 Highland Lakes Blvd, N Miami Beach, FL 33179-2813 | 2012-04-04 |
| 1841584265 | D & R Rahabilitation Service Corp | Residential Treatment Facility, Emotionally Disturbed Children | 8567 Coral Way # 156, Miami, FL 33155-2335 | 2011-06-02 |
| 1003146887 | Sequel Tsi of Florida, LLC Daytona Transitional | Residential Treatment Facility, Emotionally Disturbed Children | 1386 Indian Lake Rd, Daytona Beach, FL 32124-1001 | 2009-12-30 |
| 1568795615 | Elite Behavioral Health Center | Residential Treatment Facility, Emotionally Disturbed Children | 611 Ne 13th St, Ft Lauderdale, FL 33304-1109 | 2009-09-08 |
| Find all providers with the same taxonomy | ||||
| City | ST AUGUSTINE |
| Zip Code | 32095 |
Please comment or provide details below to improve the information on ST JOHNS YOUTH ACADEMY.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.