NPIMap

Organization Active NPI

St Augustine Youth Services

  • Mental Illness Community Based Residential Treatment Facility
  • St Augustine, FL
National Provider Identifier
1699816900
Registry record updated Aug 27, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X
License
0206-61-16 Issued in FL
Legal business name
ST AUGUSTINE YOUTH SERVICES
Practice address
201 Simone Way
St. Augustine, FL 32086
Phone
(904) 829-1770
Fax
(904) 825-0604
NPI assigned
Feb 9, 2007
Last updated
Aug 27, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 27, 2014

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

Authorized official

Name
Mrs. Schuyler S. Siefker
Title
Executive Director
Phone
(904) 829-1770

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Community Based Residential Treatment Facility 320800000X 0206-61-16 FL Primary

Addresses

Primary practice location

201 Simone Way
St. Augustine, FL 32086

Mailing address

201 Simone Way
St. Augustine, FL 32086
Phone (904) 829-1770

Other identifiers 2

IdentifierTypeStateIssuer
029585003MedicaidFL
029585000MedicaidFL

National Provider Directory

National Provider Directory
Tax ID family
Iest Augustine Youth Services2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Practitioners & affiliated clinicians

Practitioners 21

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1170979200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1409097600000",
    "number": "1699816900",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 SIMONE WAY",
            "city": "ST. AUGUSTINE",
            "state": "FL",
            "postal_code": "32086",
            "telephone_number": "904-829-1770",
            "fax_number": "904-825-0604"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 SIMONE WAY",
            "city": "ST. AUGUSTINE",
            "state": "FL",
            "postal_code": "32086",
            "telephone_number": "904-829-1770",
            "fax_number": "904-825-0604"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST AUGUSTINE YOUTH SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-09",
        "last_updated": "2014-08-27",
        "status": "A",
        "authorized_official_last_name": "SIEFKER",
        "authorized_official_first_name": "SCHUYLER",
        "authorized_official_middle_name": "S.",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "904-829-1770",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "FL",
            "license": "0206-61-16",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "029585003",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "029585000",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 Aug 27, 2014; 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.