Provider Demographics
NPI:1508900564
Name:COMMUNITY BASED CARE OF BREVARD
Entity Type:Organization
Organization Name:COMMUNITY BASED CARE OF BREVARD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:NELLIUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-752-3183
Mailing Address - Street 1:760 NORTH DR STE E
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32934-9247
Mailing Address - Country:US
Mailing Address - Phone:321-752-4650
Mailing Address - Fax:321-752-3188
Practice Address - Street 1:760 NORTH DR STE E
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32934-9247
Practice Address - Country:US
Practice Address - Phone:321-752-4650
Practice Address - Fax:321-752-3188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management