Provider Demographics
NPI:1053533596
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:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HR MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:GEMMILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-634-3688
Mailing Address - Street 1:1264 US HIGHWAY 1 STE 103
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-2746
Mailing Address - Country:US
Mailing Address - Phone:321-634-3688
Mailing Address - Fax:321-504-0955
Practice Address - Street 1:1264 US HIGHWAY 1 STE 103
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-2746
Practice Address - Country:US
Practice Address - Phone:321-634-3688
Practice Address - Fax:321-504-0955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL058384702Medicaid