Healthcare Provider Details

I. General information

NPI: 1386101368
Provider Name (Legal Business Name): FAIRVIEW AVENUE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2019
Last Update Date: 03/02/2026
Certification Date: 03/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3270 SUNTREE BLVD STE 129
MELBOURNE FL
32940-7539
US

IV. Provider business mailing address

3270 SUNTREE BLVD STE 129
MELBOURNE FL
32940-7539
US

V. Phone/Fax

Practice location:
  • Phone: 321-549-0292
  • Fax: 321-441-9747
Mailing address:
  • Phone: 321-549-0292
  • Fax: 407-572-0072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. ROB DEZSO
Title or Position: OWNER
Credential:
Phone: 407-572-0070