Provider Demographics
NPI:1881740546
Name:ST JOHNS COUNTY WELFARE FEDERATION
Entity type:Organization
Organization Name:ST JOHNS COUNTY WELFARE FEDERATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF NURSING,ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:DALHGREN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:904-824-2501
Mailing Address - Street 1:169 M L KING AVE
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32084-5139
Mailing Address - Country:US
Mailing Address - Phone:904-824-2501
Mailing Address - Fax:904-829-5507
Practice Address - Street 1:169 M L KING AVE
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32084-5139
Practice Address - Country:US
Practice Address - Phone:904-824-2501
Practice Address - Fax:904-829-5507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL108211Medicare ID - Type UnspecifiedMEDICARE - HOME HEALTH