NPIMap

Organization Active NPI

St Johns Youth Academy

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • St Augustine, FL
National Provider Identifier
1265751762
Registry record updated May 24, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X
Legal business name
ST JOHNS YOUTH ACADEMY
Practice address
4500 Avenue D
St Augustine, FL 32095-5245
Phone
(904) 829-8850
Fax
(904) 829-8851
NPI assigned
May 24, 2010
Last updated
May 24, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 24, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Barika Grayson, L.M.H.C.
Title
Clinical Director
Phone
(904) 829-8850

Specialties & licenses 2

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

Addresses

Primary practice location

4500 Avenue D
St Augustine, FL 32095-5245

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
0755AD5690-09OtherFLSUBSTANCE ABUSE LICENSE

Other names 1

  • Youth Services International, Inc. Other name

National Provider Directory

National Provider Directory
Tax ID family
Santa Rosa Youth Academy7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Locations

4500 Avenue D
Saint Augustine, FL 32095
Phone (904) 209-1320

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1274659200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1274659200000",
    "number": "1265751762",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4500 AVENUE D",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320955245",
            "telephone_number": "904-829-8850",
            "fax_number": "904-829-8851"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4500 AVENUE D",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320955245",
            "telephone_number": "904-829-8850",
            "fax_number": "904-829-8851"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST JOHNS YOUTH ACADEMY",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-05-24",
        "last_updated": "2010-05-24",
        "status": "A",
        "authorized_official_last_name": "GRAYSON",
        "authorized_official_first_name": "BARIKA",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "904-829-8850",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "L.M.H.C."
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3245S0500X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children",
            "state": "FL",
            "license": "0755AD5690-09",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SUBSTANCE ABUSE LICENSE",
            "identifier": "0755AD5690-09",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Youth Services International, Inc.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in St Augustine, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.