Provider Demographics
NPI:1518914555
Name:HOME HEALTH AGENCY- BREVARD, LLC
Entity Type:Organization
Organization Name:HOME HEALTH AGENCY- BREVARD, LLC
Other - Org Name:SUNCREST OMNI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGULATORY AFFAIRS
Authorized Official - Prefix:MS
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-707-5880
Mailing Address - Street 1:720 W OAK ST
Mailing Address - Street 2:SUITE 303
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-4989
Mailing Address - Country:US
Mailing Address - Phone:407-933-1400
Mailing Address - Fax:407-933-1450
Practice Address - Street 1:720 W OAK ST
Practice Address - Street 2:SUITE 303
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4989
Practice Address - Country:US
Practice Address - Phone:407-933-1400
Practice Address - Fax:407-933-1450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299992050251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL108064Medicare Oscar/Certification