Healthcare Provider Details

I. General information

NPI: 1538406566
Provider Name (Legal Business Name): SPACE COAST HEALTH FOUNDATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2013
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

548 BARTON BLVD STE 100
ROCKLEDGE FL
32955-3144
US

IV. Provider business mailing address

1100 ROCKLEDGE BLVD STE 100
ROCKLEDGE FL
32955-2818
US

V. Phone/Fax

Practice location:
  • Phone: 321-632-5792
  • Fax: 321-632-5796
Mailing address:
  • Phone: 321-241-6600
  • Fax: 321-690-6621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: JOHNETTE GINDLING
Title or Position: PRESIDENT/CEO
Credential:
Phone: 321-241-6600