Organization Name: | AT HOME OF BREVARD, LLC. |
NPI Number: | 1629244629 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MICHAEL JOSEPH CULLEN (ADMINISTRATOR) |
Mailing Address: | 3116 Wendel Rd Se Palm Bay |
State: | FL US |
Postal Code: | 329098469 |
Phone Number: | 3219526623 |
Fax Number: | 3219526624 |
NPI Enumeration Date: | 04/30/2008 |
NPI Last Update Date: | 04/30/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 310400000X |
License Number: | 10779 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Nursing & Custodial Care Facilities |
Taxonomy Classification: | Assisted Living Facility |
Taxonomy Specialization: | |
Taxonomy Definition: | A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. |