Healthcare Provider Details

I. General information

NPI: 1669061149
Provider Name (Legal Business Name): ONE SP INVESTMENTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2021
Last Update Date: 01/11/2021
Certification Date: 01/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

624 S ATLANTIC AVE
DAYTONA BEACH FL
32118-4510
US

IV. Provider business mailing address

624 S ATLANTIC AVE
DAYTONA BEACH FL
32118-4510
US

V. Phone/Fax

Practice location:
  • Phone: 386-258-5116
  • Fax: 386-258-6147
Mailing address:
  • Phone: 386-258-5116
  • Fax: 386-258-6147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: ANKUR SHAH
Title or Position: DIRECTOR
Credential:
Phone: 321-432-0675