Provider Demographics
NPI:1316382385
Name:BREVARD HOME CARE LLC
Entity Type:Organization
Organization Name:BREVARD HOME CARE LLC
Other - Org Name:GRISWOLD HOMECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:VENKAT
Authorized Official - Middle Name:
Authorized Official - Last Name:PUSKUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-948-8555
Mailing Address - Street 1:1185 TALON WAY
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32934-3257
Mailing Address - Country:US
Mailing Address - Phone:321-948-8555
Mailing Address - Fax:
Practice Address - Street 1:1600 SARNO RD
Practice Address - Street 2:SUITE # 119J
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-4938
Practice Address - Country:US
Practice Address - Phone:321-948-8555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-06
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care