Provider Demographics
NPI:1023013729
Name:PUTNAM COUNTY ALCOHOL & DRUG COUNCIL, INC.
Entity Type:Organization
Organization Name:PUTNAM COUNTY ALCOHOL & DRUG COUNCIL, INC.
Other - Org Name:PUTNAM-ST. JOHNS BEHAVIORAL HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHAIRPERSON BOARD OF DIRECTORS
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:C
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-325-4714
Mailing Address - Street 1:330 KAY LARKIN DR
Mailing Address - Street 2:
Mailing Address - City:PALATKA
Mailing Address - State:FL
Mailing Address - Zip Code:32177-2307
Mailing Address - Country:US
Mailing Address - Phone:386-329-3780
Mailing Address - Fax:386-385-1269
Practice Address - Street 1:330 KAY LARKIN DR
Practice Address - Street 2:
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177-2307
Practice Address - Country:US
Practice Address - Phone:386-329-3780
Practice Address - Fax:386-385-1269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-17
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X, 261QM0801X
FL0354AD252601324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251B00000XAgenciesCase Management
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL38327OtherBC/BS
FL360349100Medicaid
FL335268OtherVALUE OPTIONS
FL60023030OtherMAGELLAN
FL758545400OtherMEDICAID CARE MGMT
FL274738OtherWELLCARE
FL760471800OtherMEDICAID COMP. ACCESS
FL60023030OtherMAGELLAN