Provider Demographics
NPI:1851439608
Name:COMMUNITY ACCESS TO CHILD HEALTH OF BREVARD, INC.
Entity Type:Organization
Organization Name:COMMUNITY ACCESS TO CHILD HEALTH OF BREVARD, INC.
Other - Org Name:CATCH OF BREVARD, INC.
Other - Org Type:Other Name
Authorized Official - Title/Position:PROGRAM ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:B
Authorized Official - Last Name:ROSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:321-637-7700
Mailing Address - Street 1:2565 JUDGE FRAN JAMIESON WAY
Mailing Address - Street 2:
Mailing Address - City:VIERA
Mailing Address - State:FL
Mailing Address - Zip Code:32940-5998
Mailing Address - Country:US
Mailing Address - Phone:321-637-7700
Mailing Address - Fax:321-637-7707
Practice Address - Street 1:2565 JUDGE FRAN JAMIESON WAY
Practice Address - Street 2:
Practice Address - City:VIERA
Practice Address - State:FL
Practice Address - Zip Code:32940-5998
Practice Address - Country:US
Practice Address - Phone:321-637-7700
Practice Address - Fax:321-637-7707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL058384700Medicaid
FL811059000Medicaid
FL058384701Medicaid
FL058384702Medicaid
FL885356800Medicaid