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General NPI Number Information
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NPI Number | 1174795454
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Entity Type | Organization
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Legal Business Name | BREVARD ALZHEIMER'S FOUNDATION, INC.
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Dates
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Enumeration Date | 03/27/2008
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Last Update Date | 07/19/2022
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Provider Practice Location Address
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Address Line | 4676 N WICKHAM RD
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City | MELBOURNE
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State | FL
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Zip | 32935-7103
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Country | US
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Telephone | 321-253-4430
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Fax | 321-757-6971
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Provider Business Mailing Address
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Address Line | 4676 N WICKHAM RD
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City | MELBOURNE
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State | FL
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Zip | 32935-7103
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Country | US
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Telephone | 321-253-4430
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Fax | 321-253-1993
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. TIMOTHY VICTOR TIMMERMANN JR.
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Credential |
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Telephone | 321-253-4430
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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