| Organization Name: | THE BREVARD HEALTH ALLIANCE INC |
| NPI Number: | 1013355726 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ANGELA CRAIG (BUSINESS OFFICE MANAGER) |
| Mailing Address: | 2120 Sarno Rd Melbourne |
| State: | FL US |
| Postal Code: | 329353084 |
| Phone Number: | 3219529696 |
| Fax Number: | 3219527937 |
| NPI Enumeration Date: | 06/05/2013 |
| NPI Last Update Date: | 12/01/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QF0400X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Federally Qualified Health Center (FQHC) |
| Taxonomy Definition: | |