Organization
BREVARD INDEPENDENT SUPPORTIVE SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHIRLENE WADE (OWNER)
(321) 557-2459
Entity
Organization
Contact information
Practice address
120 HARRISON ST STE 10, COCOA, FL 32922-7936
(321) 557-2459
Mailing address
229 LIME ST, COCOA, FL 32926-4140
(321) 557-2459
Taxonomy
Speciality
Code
Description
License number
State
3747P1801X
Personal Care Attendant
Primary
—
—
Other
Enumeration date
10/29/2025
Last updated
03/05/2026
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