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General NPI Number Information
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NPI Number | 1902214588
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Entity Type | Organization
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Legal Business Name | CANCER CARE CENTERS OF BREVARD
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Dates
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Enumeration Date | 07/28/2014
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Last Update Date | 08/31/2020
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Provider Practice Location Address
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Address Line | 1048 HARVIN WAY
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City | ROCKLEDGE
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State | FL
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Zip | 32955
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Country | US
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Telephone | 321-636-2111
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Fax | 321-636-7180
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Provider Business Mailing Address
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Address Line | 1048 HARVIN WAY
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City | ROCKLEDGE
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State | FL
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Zip | 32955
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Country | US
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Telephone | 321-636-2111
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Fax | 321-636-7180
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Authorized Official
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Title or Position | DIRECTOR OF CLINICAL SERVICES
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Name | MS. GAIL K ERENTREICH
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Credential |
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Telephone | 321-636-2111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number | 64498
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License Number State | FL
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