Provider Demographics
NPI:1730523036
Name:BREVARD HMA ALF LLC
Entity type:Organization
Organization Name:BREVARD HMA ALF LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MEGHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GUY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-255-6030
Mailing Address - Street 1:1700 WUESTHOFF DR
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-6842
Mailing Address - Country:US
Mailing Address - Phone:321-255-6030
Mailing Address - Fax:321-255-3075
Practice Address - Street 1:1700 WUESTHOFF DR
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-6842
Practice Address - Country:US
Practice Address - Phone:321-255-6030
Practice Address - Fax:321-255-3075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-18
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL8134310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility