Provider Demographics
NPI:1801156716
Name:BARTON HOUSE OF BREVARD, INC.
Entity type:Organization
Organization Name:BARTON HOUSE OF BREVARD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:JEAN-PIERRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-368-1064
Mailing Address - Street 1:571 DEGROODT RD SW
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32908-7420
Mailing Address - Country:US
Mailing Address - Phone:321-368-1064
Mailing Address - Fax:321-216-9274
Practice Address - Street 1:571 DEGROODT RD SW
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32908-7420
Practice Address - Country:US
Practice Address - Phone:321-368-1064
Practice Address - Fax:321-216-9274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-24
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12190310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility