BREVARD HEALTH ALLIANCE (NPI# 1679622120) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1679622120 |
| Entity Type | Organization |
| Organization Name | BREVARD HEALTH ALLIANCE |
| Practice Address |
5270 Babcock St Ne # St1 Palm Bay FL 32905-8630 |
| Practice Telephone | 3217225959 |
| Mailing Telephone | 3217225959 |
| Enumeration Date | 2007-01-10 |
| Last Update Date | 2010-11-04 |
| Authorized Official Name | MARSHA VENDETTI (OPERATIONS MANAGER) |
| Authorized Official Telephone | 3217225970 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | 6886931-01 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952451239 | Brevard Health Alliance | Clinic/Center | 15 Rosa L Jones Blvd, Cocoa, FL 32922-7899 | 2007-01-11 |
| 1528330826 | Brevard Health Alliance | Clinic/Center | 775 Malabar Rd, Malabar, FL 32950-3120 | 2012-02-01 |
| 1336444637 | Brevard Health Alliance | Clinic/Center | 500 N Washington Ave, Suite 105, Titusville, FL 32796-2759 | 2011-01-18 |
| 1174674956 | Brevard Health Alliance | Clinic/Center | 5270 Babcock St Ne # St1, Palm Bay, FL 32905-8630 | 2007-01-16 |
| 1518017896 | Brevard Health Alliance | Clinic/Center | 220 Barton Blvd, Unit C14, Rockledge, FL 32955-2742 | 2007-01-11 |
| 1619026218 | Brevard Health Alliance | Clinic/Center | 17 Silver Palm Ave, Melbourne, FL 32901-3123 | 2007-01-10 |
| 1992750962 | Brevard Health Alliance | Clinic/Center | 5270 Babcock St Ne, Suite 1, Palm Bay, FL 32905-8630 | 2006-05-24 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | BREVARD HEALTH ALLIANCE, INC., THE | 5270 Babcock St Ne Ste 1, Palm Bay, FL 32905-4616 |
| Street Address |
5270 BABCOCK ST NE # ST1 |
| City | PALM BAY |
| State | FL |
| Zip Code | 32905-8630 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174674956 | Brevard Health Alliance | Clinic/Center | 5270 Babcock St Ne # St1, Palm Bay, FL 32905-8630 | 2007-01-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306460928 | Lavell Woodard Jr. | Counselor | 4206 Pinewood Dr Ne, Palm Bay, FL 32905 | 2020-05-29 |
| 1548735699 | Aaron J Milton | Counselor | 1420 Sportsman Lane Ne, Palm Bay, FL 32905 | 2018-10-04 |
| 1871070417 | The Brevard Health Alliance Inc | Clinic/Center | 1361 Florida Ave Ne Ste 2, Palm Bay, FL 32905 | 2018-07-26 |
| 1699266361 | Coastal Visioncare LLC | Optometrist | 2186 Harris Ave Ne Ste 1, Palm Bay, FL 32905 | 2018-05-29 |
| 1184173981 | Jean Elyse Gautreaux | Social Worker | 2475 Palm Bay Rd Ne, Suite 130 #4, Palm Bay, FL 32905 | 2016-09-22 |
| 1174901607 | Reginald Shannon Seecharan | Developmental Therapist | 700 James Cir Ne, Palm Bay, FL 32905 | 2015-05-17 |
| 1881091254 | Courtney Taft | Physical Therapy Assistant | 1155 Malabar Road, Suite 1, Palm Bay, FL 32905 | 2014-12-01 |
| 1548513310 | Juda Marie Decara | Counselor | 4690 Lipscomb St Se, Suite 6c, Palm Bay, FL 32905 | 2012-10-18 |
| 1326308313 | Mohammad Idrees Md, P.a. | Internal Medicine | 1454 Belaire Lane N.e., Palm Bay, FL 32905 | 2012-05-23 |
| 1265704548 | Atm Amin Dds LLC | Dentist | 4620 Lipscomb St Ne, Suite 2, Palm Bay, FL 32905 | 2012-02-02 |
| Find all providers in zip 32905 | ||||
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871070417 | The Brevard Health Alliance Inc | Clinic/Center | 1361 Florida Ave Ne Ste 2, Palm Bay, FL 32905 | 2018-07-26 |
| 1174674956 | Brevard Health Alliance | Clinic/Center | 5270 Babcock St Ne # St1, Palm Bay, FL 32905-8630 | 2007-01-16 |
| 1316004815 | Brevard Health Alliance Inc | Clinic/Center | 5270 Babcock St Ne Ste 1, Palm Bay, FL 32905-4616 | 2007-01-03 |
| 1992750962 | Brevard Health Alliance | Clinic/Center | 5270 Babcock St Ne, Suite 1, Palm Bay, FL 32905-8630 | 2006-05-24 |
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| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.