Healthcare Provider Details

I. General information

NPI: 1114905940
Provider Name (Legal Business Name): SMA HEALTHCARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2006
Last Update Date: 07/15/2021
Certification Date: 07/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1341 INDIAN LAKE RD
DAYTONA BEACH FL
32124-1039
US

IV. Provider business mailing address

1341 INDIAN LAKE RD
DAYTONA BEACH FL
32124-1039
US

V. Phone/Fax

Practice location:
  • Phone: 386-254-1186
  • Fax: 386-236-3175
Mailing address:
  • Phone: 386-236-3225
  • Fax: 386-236-3175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number1264AD6866-01
License Number StateFL

VIII. Authorized Official

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