Organization
EVENING TIDE OF BREVARD, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. STEVEN DOUGLAS TRACY NA (EXECUTIVE DIRECTOR)
(435) 760-4091
Entity
Organization
Contact information
Practice address
100 N ORLANDO AVE, COCOA BEACH, FL 32931-2915
(321) 613-4569
(321) 613-0217
Mailing address
100 N ORLANDO AVE, COCOA BEACH, FL 32931-2915
(321) 613-4569
(321) 613-0217
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
Other
Enumeration date
04/01/2016
Last updated
04/01/2016
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