Organization
AT HOME OF BREVARD, LLC.
Active
Other names
Golden Wings Wendel
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL JOSEPH CULLEN (ADMINISTRATOR)
(321) 676-6331
Entity
Organization
Contact information
Practice address
3116 WENDEL RD SE, PALM BAY, FL 32909-8469
(321) 952-6623
(321) 952-6624
Mailing address
1351 DARROW RD SW, PALM BAY, FL 32908-6248
(321) 676-6331
(321) 951-2118
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
10779
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6931120 00
—
FL
Enumeration date
04/30/2008
Last updated
04/30/2008
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