# BREVARD HEALTH ALLIANCE INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Family Promise Firehouse Clinic
- **Organization subpart:** No

## Provider details

- **NPI number:** 1396511374
- **Authorized official:** ANGELA CRAIG (DIRECTOR OF BILLING)
- **Authorized official phone:** (321) 241-6834

## Contact information

- **Practice address:** 114 1ST ST OFC 137, COCOA, FL 32922-7767
- **Practice address phone:** (321) 241-6800
- **Practice address fax:** (321) 241-6890
- **Mailing address:** PO BOX 1137, MELBOURNE, FL 32902-1137
- **Mailing address phone:** (321) 952-9696
- **Mailing address fax:** (321) 952-7937

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 11/30/2023
- **Last updated:** 11/30/2023