Provider Demographics
NPI:1538406566
Name:SPACE COAST HEALTH FOUNDATION, INC.
Entity type:Organization
Organization Name:SPACE COAST HEALTH FOUNDATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JOHNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:GINDLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-637-2606
Mailing Address - Street 1:1100 ROCKLEDGE BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-2818
Mailing Address - Country:US
Mailing Address - Phone:321-241-6600
Mailing Address - Fax:321-690-6621
Practice Address - Street 1:505 BREVARD AVE STE 106
Practice Address - Street 2:
Practice Address - City:COCOA
Practice Address - State:FL
Practice Address - Zip Code:32922-7973
Practice Address - Country:US
Practice Address - Phone:321-632-5792
Practice Address - Fax:321-632-5796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-10
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251K00000XAgenciesPublic Health or Welfare