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General NPI Number Information
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NPI Number | 1568760429
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Entity Type | Organization
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Legal Business Name | ARK CENTER OF BREVARD
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Dates
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Enumeration Date | 03/02/2011
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Last Update Date | 03/02/2011
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Provider Practice Location Address
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Address Line | 1574 MANZANITA ST NW
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City | PALM BAY
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State | FL
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Zip | 32907-7011
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Country | US
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Telephone | 321-574-0309
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Fax | 321-574-0309
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Provider Business Mailing Address
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Address Line | 1574 MANZANITA ST NW
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City | PALM BAY
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State | FL
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Zip | 32907-7011
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Country | US
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Telephone | 321-574-0309
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Fax | 321-574-0309
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. NADEN GERMAIN
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Credential |
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Telephone | 321-574-0309
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 11359
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License Number State | FL
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