Provider Demographics
NPI:1891931614
Name:LIFE CARE SAINT JOHNS
Entity Type:Organization
Organization Name:LIFE CARE SAINT JOHNS
Other - Org Name:GLENMOOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTI
Authorized Official - Middle Name:
Authorized Official - Last Name:QUICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-273-1701
Mailing Address - Street 1:235 TOWERVIEW DR
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32092-2790
Mailing Address - Country:US
Mailing Address - Phone:904-940-4800
Mailing Address - Fax:904-940-4820
Practice Address - Street 1:230 TOWERVIEW DR
Practice Address - Street 2:
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32092-2789
Practice Address - Country:US
Practice Address - Phone:904-201-7055
Practice Address - Fax:904-201-7040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-29
Last Update Date:2008-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation