Healthcare Provider Details

I. General information

NPI: 1487955977
Provider Name (Legal Business Name): SMA HEALTHCARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2010
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 JUSTICE LN
BUNNELL FL
32110-4487
US

IV. Provider business mailing address

150 MAGNOLIA AVE
DAYTONA BEACH FL
32114-4304
US

V. Phone/Fax

Practice location:
  • Phone: 800-478-0331
  • Fax: 386-236-3178
Mailing address:
  • Phone: 386-236-3200
  • Fax: 386-236-3178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number0718AD5986-41
License Number StateFL

VIII. Authorized Official

Name: MR. IVAN A COSIMI
Title or Position: CEO/PRESIDENT
Credential:
Phone: 386-236-1811