Healthcare Provider Details

I. General information

NPI: 1750348215
Provider Name (Legal Business Name): BREVARD HMA NURSING HOME, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 01/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8050 SPYGLASS HILL RD
VIERA FL
32940-7983
US

IV. Provider business mailing address

8050 SPYGLASS HILL RD
VIERA FL
32940-7983
US

V. Phone/Fax

Practice location:
  • Phone: 321-752-1000
  • Fax:
Mailing address:
  • Phone: 321-752-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberSNF16320961
License Number StateFL

VIII. Authorized Official

Name: LAURIE HOLTSFORD
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 615-465-7466