Provider Demographics
NPI:1396466652
Name:CASE MANAGEMENT SERVICES OF BREVARD, INC.
Entity type:Organization
Organization Name:CASE MANAGEMENT SERVICES OF BREVARD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:HEINLY
Authorized Official - Suffix:
Authorized Official - Credentials:BSW, MDIV
Authorized Official - Phone:321-265-1647
Mailing Address - Street 1:2500 WOODLAKE DR NE APT 101
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32905-3239
Mailing Address - Country:US
Mailing Address - Phone:132-126-5164
Mailing Address - Fax:
Practice Address - Street 1:2500 WOODLAKE DR NE APT 101
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-3239
Practice Address - Country:US
Practice Address - Phone:132-126-5164
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-06
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management