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General NPI Number Information
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NPI Number | 1669061149
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Entity Type | Organization
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Legal Business Name | ONE SP INVESTMENTS LLC
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Dates
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Enumeration Date | 01/11/2021
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Last Update Date | 01/11/2021
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Provider Practice Location Address
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Address Line | 624 S ATLANTIC AVE
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City | DAYTONA BEACH
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State | FL
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Zip | 32118-4510
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Country | US
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Telephone | 386-258-5116
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Fax | 386-258-6147
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Provider Business Mailing Address
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Address Line | 624 S ATLANTIC AVE
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City | DAYTONA BEACH
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State | FL
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Zip | 32118-4510
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Country | US
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Telephone | 386-258-5116
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Fax | 386-258-6147
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Authorized Official
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Title or Position | DIRECTOR
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Name | ANKUR SHAH
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Credential |
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Telephone | 321-432-0675
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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License Number |
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License Number State |
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