# BREVARD HEALTH ALLIANCE

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Heritage Park
- **Organization subpart:** No

## Provider details

- **NPI number:** 1558088070
- **Authorized official:** ANGELA CRAIG (DIRECTOR OF BILLING)
- **Authorized official phone:** (321) 698-3446

## Contact information

- **Practice address:** 2550 GRANT ST STE 137, MELBOURNE, FL 32901-6006
- **Practice address phone:** (321) 334-6940
- **Practice address fax:** (321) 334-6912
- **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:** 10/25/2022
- **Last updated:** 10/25/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 688693129 | — | FL |