=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790302024
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SMART ENDEAVORS THERAPY SERVICES, LLC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/02/2020
-----------------------------------------------------
Last Update Date | 07/02/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1222 SE 47TH ST
-----------------------------------------------------
City | CAPE CORAL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33904-9661
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-888-9696
-----------------------------------------------------
Fax | 239-567-5878
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1222 SE 47TH ST
-----------------------------------------------------
City | CAPE CORAL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33904-9661
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-888-9696
-----------------------------------------------------
Fax | 239-567-5878
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ALEXANDER J GARCIA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 239-888-9696
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM1300X
-----------------------------------------------------
Taxonomy Name | Multi-Specialty Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------