Provider Demographics
NPI:1710431549
Name:BREVARD CARES
Entity Type:Organization
Organization Name:BREVARD CARES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MILES
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:321-632-2737
Mailing Address - Street 1:4085 US HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-5307
Mailing Address - Country:US
Mailing Address - Phone:321-632-2737
Mailing Address - Fax:321-633-1963
Practice Address - Street 1:4085 US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-5307
Practice Address - Country:US
Practice Address - Phone:321-632-2737
Practice Address - Fax:321-633-1963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-10
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty