Provider Demographics
NPI:1700819091
Name:2-1-1 BREVARD, INC.
Entity Type:Organization
Organization Name:2-1-1 BREVARD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:B
Authorized Official - Last Name:DONOGHUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-631-9290
Mailing Address - Street 1:PO BOX 417
Mailing Address - Street 2:
Mailing Address - City:COCOA
Mailing Address - State:FL
Mailing Address - Zip Code:32923-0417
Mailing Address - Country:US
Mailing Address - Phone:321-631-9290
Mailing Address - Fax:321-631-9291
Practice Address - Street 1:625 FLORIDA AVE
Practice Address - Street 2:STE. 4
Practice Address - City:COCOA
Practice Address - State:FL
Practice Address - Zip Code:32922-7970
Practice Address - Country:US
Practice Address - Phone:321-631-9290
Practice Address - Fax:321-631-9291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable