Provider Demographics
NPI:1487630729
Name:ASSOCIATION FOR RETARDED CITIZENS
Entity type:Organization
Organization Name:ASSOCIATION FOR RETARDED CITIZENS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:FAY
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-225-9355
Mailing Address - Street 1:86051 HAMILTON ST
Mailing Address - Street 2:
Mailing Address - City:YULEE
Mailing Address - State:FL
Mailing Address - Zip Code:32097-2711
Mailing Address - Country:US
Mailing Address - Phone:904-225-9355
Mailing Address - Fax:904-225-9262
Practice Address - Street 1:86051 HAMILTON ST
Practice Address - Street 2:
Practice Address - City:YULEE
Practice Address - State:FL
Practice Address - Zip Code:32097-2711
Practice Address - Country:US
Practice Address - Phone:904-225-9355
Practice Address - Fax:904-225-9262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLF002347C00000X, 385HR2060X, 253Z00000X, 251C00000X
FL251C00000X251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No347C00000XTransportation ServicesPrivate Vehicle
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL098929198Medicaid
FL098929196Medicaid
FL098929196OtherPROVIDER ID