Healthcare Provider Details

I. General information

NPI: 1215369376
Provider Name (Legal Business Name): BREVARD CARES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2013
Last Update Date: 10/20/2021
Certification Date: 10/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4085 S US HIGHWAY 1
ROCKLEDGE FL
32955-5307
US

IV. Provider business mailing address

4085 S US HIGHWAY 1
ROCKLEDGE FL
32955-5307
US

V. Phone/Fax

Practice location:
  • Phone: 321-632-2767
  • Fax: 321-633-1977
Mailing address:
  • Phone: 321-632-2737
  • Fax: 321-633-1977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. KATHRYN PARKER
Title or Position: INTERIM EXECUTIVE DIRECTOR
Credential: LMHC #14889
Phone: 321-632-2737