Organization
BREVARD HEALTH ALLIANCE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANGELA CRAIG (BUSINESS OFFICE MANAGER)
(321) 241-6834
Entity
Organization
Contact information
Practice address
17 SILVER PALM AVE, MELBOURNE, FL 32901-3123
(321) 733-2021
(321) 727-0884
Mailing address
PO BOX 1137, MELBOURNE, FL 32902-1137
(321) 952-9696
(321) 952-7937
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6886931-03
—
FL
Enumeration date
01/10/2007
Last updated
08/17/2016
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