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General NPI Number Information
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NPI Number | 1396356119
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Entity Type | Organization
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Legal Business Name | VNA SPACE COAST PRIVATE CARE, INC
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Dates
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Enumeration Date | 08/14/2020
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Last Update Date | 10/09/2025
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Provider Practice Location Address
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Address Line | 391 COMMERCE PKWY STE 240-260
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City | ROCKLEDGE
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State | FL
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Zip | 32955-4209
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Country | US
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Telephone | 321-752-7550
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Fax | 321-417-3394
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Provider Business Mailing Address
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Address Line | 958 20TH PL FL 2
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City | VERO BEACH
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State | FL
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Zip | 32960-6420
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Country | US
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Telephone | 772-978-5585
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Fax | 772-978-5509
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Authorized Official
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Title or Position | VP OF CLINICAL OPERATIONS
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Name | MR. JACQUELINE KEVILLE
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Credential |
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Telephone | 772-538-2504
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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