Organization
BREVARD HEALTH ALLIANCE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARSHA VENDETTI (OPERATIONS MANAGER)
(321) 722-5970
Entity
Organization
Contact information
Practice address
15 ROSA L JONES BLVD, COCOA, FL 32922-7899
(321) 639-5177
Mailing address
15 ROSA L JONES BLVD, COCOA, FL 32922-7899
(321) 639-5177
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6886931-09
—
FL
Enumeration date
01/11/2007
Last updated
11/04/2010
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