Organization
BREVARD ASSISTED LIVING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHNNIE MESAROS R.PH (CEO/OWNER)
(321) 693-4269
Entity
Organization
Contact information
Practice address
3831 FUNSTON CIR, MELBOURNE, FL 32940-8583
(321) 693-4269
(321) 406-0298
Mailing address
9060 S TROPICAL TRL, MERRITT ISLAND, FL 32952-6803
(321) 693-4269
(321) 406-0298
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
11779
FL
Other
Enumeration date
06/07/2011
Last updated
06/07/2011
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