Provider Demographics
NPI:1043191505
Name:ST AUBYN CORP
Entity type:Organization
Organization Name:ST AUBYN CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KERROL
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-330-6312
Mailing Address - Street 1:468 COLUMBIA CT
Mailing Address - Street 2:
Mailing Address - City:POINCIANA
Mailing Address - State:FL
Mailing Address - Zip Code:34759-5959
Mailing Address - Country:US
Mailing Address - Phone:954-268-8911
Mailing Address - Fax:
Practice Address - Street 1:468 COLUMBIA CT
Practice Address - Street 2:
Practice Address - City:POINCIANA
Practice Address - State:FL
Practice Address - Zip Code:34759-5959
Practice Address - Country:US
Practice Address - Phone:954-268-8911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-10
Last Update Date:2025-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities