NPIMap

Organization Active NPI

Foundations Pediatrics Assessment and Treatment Center

  • Community/Behavioral Health Agency
  • St Augustine, FL
National Provider Identifier
1841649241
Registry record updated Apr 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
FOUNDATIONS PEDIATRICS ASSESSMENT AND TREATMENT CENTER
Practice address
495 Prosperity Lake Dr Ste 101
Saint Augustine, FL 32092-5045
Phone
(954) 895-3006
NPI assigned
Jun 7, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 16, 2024

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

Authorized official

Name
Jillene Driest, PH.D.
Title
Owner
Phone
(954) 895-3006

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

495 Prosperity Lake Dr Ste 101
Saint Augustine, FL 32092-5045

Mailing address

495 Prosperity Lake Dr Ste 101
Saint Augustine, FL 32092-5045
Phone (954) 895-3006

Other practice location 1

245 Land Grant Street
Suite 3
Saint Augustine, FL 32092
Phone (904) 370-3420

National Provider Directory

National Provider Directory
Tax ID family
Foundations Pediatrics Assessment and Treatment Center2 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.

Locations

245 Land Grant St
Unit 3
Saint Augustine, FL 32092
Phone (904) 370-3420

495 Prosperity Lake Dr
#101
Saint Augustine, FL 32092
Phone (904) 294-7721

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1465257600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1713225600000",
    "number": "1841649241",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "495 PROSPERITY LAKE DR STE 101",
            "city": "SAINT AUGUSTINE",
            "state": "FL",
            "postal_code": "320925045",
            "telephone_number": "954-895-3006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "495 PROSPERITY LAKE DR STE 101",
            "city": "SAINT AUGUSTINE",
            "state": "FL",
            "postal_code": "320925045",
            "telephone_number": "954-895-3006"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "245 Land Grant Street",
            "address_2": "Suite 3",
            "address_purpose": "LOCATION",
            "city": "Saint Augustine",
            "state": "FL",
            "postal_code": "32092",
            "country_code": "US",
            "telephone_number": "904-370-3420",
            "fax_number": "904-512-3845",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "FOUNDATIONS PEDIATRICS ASSESSMENT AND TREATMENT CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-07",
        "last_updated": "2024-04-16",
        "certification_date": "2024-04-16",
        "status": "A",
        "authorized_official_last_name": "DRIEST",
        "authorized_official_first_name": "JILLENE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "954-895-3006",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "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 Apr 16, 2024; 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.