| Organization Name: | BREVARD HEALTH ALLIANCE INC |
| NPI Number: | 1073855797 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ANGELA CRAIG (BUSINESS OFFICE MANAGER) |
| Mailing Address: | 4000 N Riverside Dr Indian Harbour Beach |
| State: | FL US |
| Postal Code: | 329374842 |
| Phone Number: | 3219145557 |
| Fax Number: | 3214341975 |
| NPI Enumeration Date: | 03/20/2013 |
| NPI Last Update Date: | 04/01/2013 |
| 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: | |