Healthcare Provider Details

I. General information

NPI: 1902083264
Provider Name (Legal Business Name): FAGAN ASSOCIATES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2008
Last Update Date: 01/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

933 BEVILLE RD SUITE 101-G
SOUTH DAYTONA FL
32119-1755
US

IV. Provider business mailing address

933 BEVILLE RD SUITE 101-G
SOUTH DAYTONA FL
32119-1755
US

V. Phone/Fax

Practice location:
  • Phone: 386-255-0645
  • Fax: 386-255-6222
Mailing address:
  • Phone: 386-255-0645
  • Fax: 386-255-6222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number227270
License Number StateFL

VIII. Authorized Official

Name: MISS THERESA SMITH
Title or Position: OFFICE MANAGER
Credential:
Phone: 386-255-0645