Mandic Group Inc

Primary specialty

Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X

License

4075096 Issued in FL

Legal business name

MANDIC GROUP INC

Doing business as

d/b/a St. Augustine Center for Living

Practice address

5155 US Highway 1 S
St Augustine, FL 32086-7855

Phone

(904) 797-5027

Fax

(904) 797-5577

NPI assigned

Sep 17, 2007

Last updated

Sep 17, 2007By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Mark Mandic

Title

Owner/Pres.

Phone

(904) 797-5027

Specialties & licenses 1

Addresses

Other names 1

• d/b/a St. Augustine Center for Living Doing business as

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

{
    "created_epoch": "1189987200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1189987200000",
    "number": "1912193673",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5155 US HIGHWAY 1 S",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320867855",
            "telephone_number": "904-797-5027",
            "fax_number": "904-797-5577"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5155 US HIGHWAY 1 S",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320867855",
            "telephone_number": "904-797-5027",
            "fax_number": "904-797-5577"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MANDIC GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-17",
        "last_updated": "2007-09-17",
        "status": "A",
        "authorized_official_last_name": "MANDIC",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "OWNER/PRES.",
        "authorized_official_telephone_number": "904-797-5027",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "FL",
            "license": "4075096",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "d/b/a St. Augustine Center for Living",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Elyssa Male, M.S. CCC-SLP
• Amir A Malik, MD
• Michael A Malone, LMHC
• Elizabeth Maltby
• Diana Hope Manderson, APRN
• Dennis Maneja
• Monali Manikal, M.D
• Vivek M Manikal, MD
• Benjamin Manning
• Emily Manning, RBT

• Intellectual and/or Developmental Disabilities Residential Treatment Facility in St Augustine, FL
• Providers in St Augustine, FL by specialty
• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2007; 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.