Provider Demographics
NPI:1801252887
Name:BREVARD HOPE CENTER
Entity type:Organization
Organization Name:BREVARD HOPE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:TWANNETTE
Authorized Official - Middle Name:T
Authorized Official - Last Name:JEFFRESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-735-2696
Mailing Address - Street 1:101 BRANDY CREEK CIR SE
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32909-2331
Mailing Address - Country:US
Mailing Address - Phone:321-735-2696
Mailing Address - Fax:321-270-8885
Practice Address - Street 1:101 W BREVARD DR
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-6709
Practice Address - Country:US
Practice Address - Phone:321-735-2696
Practice Address - Fax:321-270-8885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-06
Last Update Date:2016-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility