Organization
BREVARD HEALTH ALLIANCE INC
Active
Other names
Malabar Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
ANGELA CRAIG (BUSINESS OFFICE MANAGER)
(321) 952-9696
Entity
Organization
Contact information
Practice address
775 MALABAR RD, MALABAR, FL 32950-3120
(321) 722-8435
(321) 722-8486
Mailing address
775 MALABAR RD, MALABAR, FL 32950-3120
(321) 722-8435
(321) 722-8486
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6886931-14
—
FL
Enumeration date
01/20/2012
Last updated
04/04/2013
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