Provider Demographics
NPI:1184952236
Name:BREVARD COMMUNITY HEALTH SERVICES, INC.
Entity type:Organization
Organization Name:BREVARD COMMUNITY HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:AL
Authorized Official - Middle Name:
Authorized Official - Last Name:O'CONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-725-4500
Mailing Address - Street 1:2226 SARNO RD STE 111
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-3087
Mailing Address - Country:US
Mailing Address - Phone:321-751-6390
Mailing Address - Fax:321-751-6389
Practice Address - Street 1:2226 SARNO RD STE 111
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-3087
Practice Address - Country:US
Practice Address - Phone:321-751-6390
Practice Address - Fax:321-751-6389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-01
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL108053OtherMEDICARE IDENTIFICATION NUMBER