=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366409153
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BREVARD HMA HOME HEALTH, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/27/2006
-----------------------------------------------------
Last Update Date | 05/16/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8060 SPYGLASS HILL RD
-----------------------------------------------------
City | VIERA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32940-7983
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 321-253-2200
-----------------------------------------------------
Fax | 321-255-8145
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 51266
-----------------------------------------------------
City | LAFAYETTE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70505-1266
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 337-233-1307
-----------------------------------------------------
Fax | 337-443-4154
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | JOSHUA L PROFFITT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 337-233-1307
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | HHA20201096
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------