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General NPI Number Information
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NPI Number | 1487955977
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Entity Type | Organization
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Legal Business Name | SMA HEALTHCARE INC
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Dates
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Enumeration Date | 11/15/2010
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Last Update Date | 09/15/2025
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Provider Practice Location Address
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Address Line | 301 JUSTICE LN
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City | BUNNELL
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State | FL
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Zip | 32110-4487
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Country | US
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Telephone | 800-478-0331
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Fax | 386-236-3178
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Provider Business Mailing Address
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Address Line | 150 MAGNOLIA AVE
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City | DAYTONA BEACH
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State | FL
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Zip | 32114-4304
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Country | US
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Telephone | 386-236-3200
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Fax | 386-236-3178
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Authorized Official
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Title or Position | CEO/PRESIDENT
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Name | MR. IVAN A COSIMI
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Credential |
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Telephone | 386-236-1811
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 0718AD5986-41
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License Number State | FL
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