Organization
BREVARD HEALTH ALLIANCE INC
Active
Other names
Central County Mobile Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
ANGELA CRAIG (BUSINESS OFFICE MANAGER)
(321) 952-9696
Entity
Organization
Contact information
Practice address
220 BARTON BLVD, UNIT #C14, ROCKLEDGE, FL 32955-2742
(321) 639-5177
(321) 639-4927
Mailing address
220 BARTON BLVD, UNIT #C14, ROCKLEDGE, FL 32955-2742
(321) 639-5177
(321) 639-4927
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6886931-08
—
FL
Enumeration date
01/08/2007
Last updated
02/18/2014
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