ST JOHNS YOUTH ACADEMY NPI 1265751762

NPI Information

NPI: 1265751762
Provider Name: ST JOHNS YOUTH ACADEMY
Classification: Residential Treatment Facility, Emotionally Disturbed Children - 322D00000X
Entity Type: Organization
Other Name: YOUTH SERVICES INTERNATIONAL, INC.
CLIA Number: 10D0894594
Address: 4500 AVENUE D
ST AUGUSTINE, FL
ZIP 32095
Phone: (904) 829-8850

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NPI Details

ST JOHNS YOUTH ACADEMY is a residential treatment facility emotionally disturbed children in St Augustine, FL. The provider is a residential facility that provides habilitation services and other care and treatment to children diagnosed with mental health illness, behavioral issues, and intellectual disabilities and are not able to live independently. ST JOHNS YOUTH ACADEMY NPI is 1265751762. The provider is registered as an organization entity type.
The provider Other Name Is Youth Services International, Inc..

The provider's business location address is:

4500 AVENUE D
ST AUGUSTINE, FL
ZIP 32095-245
Phone: (904) 829-8850
Fax: (904) 829-8851

The provider's authorized official is Barika Grayson .
The authorized official title is Clinical Director and has the following contact phone number (904) 829-8850.

The CLIA number assigned to this NPI record is 10D0894594 - mobile laboratory with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 5/24/2010 and was last updated on 5/24/2010.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	3245S0500X	Substance Abuse Rehabilitation Facility	Substance Abuse Treatment, Children	0755AD5690-09	FLORIDA	No
2	322D00000X	Residential Treatment Facility, Emotionally Disturbed Children				Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	0755AD5690-09	OTHER	FLORIDA	SUBSTANCE ABUSE LICENSE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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