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General NPI Number Information
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NPI Number | 1811994270
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Entity Type | Organization
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Legal Business Name | VNA SPACE COAST, INC.
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Dates
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Enumeration Date | 06/30/2005
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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 | 772-567-5551
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Fax | 772-569-1444
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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 | 772-567-5551
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Fax | 772-569-1444
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Authorized Official
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Title or Position | VP OF CLINICAL OPERATIONS
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Name | JACQUELINE MARY 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 | HHA299991471
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License Number State | FL
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