Organization Name: | THE BREVARD HEALTH ALLIANCE INC |
NPI Number: | 1104121300 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | ANGELA CRAIG (BUSINESS OFFICE MANAGER) |
Mailing Address: | 705 Blake Ave Bldg G Cocoa |
State: | FL US |
Postal Code: | 329227100 |
Phone Number: | 3216336391 |
Fax Number: | 3216336441 |
NPI Enumeration Date: | 01/19/2011 |
NPI Last Update Date: | 01/20/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QF0400X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Federally Qualified Health Center (FQHC) |
Taxonomy Definition: |