Provider Demographics
NPI:1568918605
Name:BREVARD AFFORDABLE HOME CARE AGENCY, INC.
Entity Type:Organization
Organization Name:BREVARD AFFORDABLE HOME CARE AGENCY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DENA MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DEVARNEY
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATOR
Authorized Official - Phone:877-404-9995
Mailing Address - Street 1:2460 N COURTENAY PKWY STE 103
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32953-4193
Mailing Address - Country:US
Mailing Address - Phone:877-404-9995
Mailing Address - Fax:877-404-9995
Practice Address - Street 1:2460 N COURTENAY PKWY STE 103
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32953-4193
Practice Address - Country:US
Practice Address - Phone:877-404-9995
Practice Address - Fax:877-404-9995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-29
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL234339253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care