MEDICARE: BREVARD COMMUNITY HEALTH SERVICES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	108053	OTHER	FL	MEDICARE IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1184952236
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BREVARD COMMUNITY HEALTH SERVICES, INC.

Provider Business Mailing Address
First Line	:	2226 SARNO RD STE 111
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32935-3087
Country	:	US
Telephone Number	:	321-751-6390
Fax Number	:	321-751-6389

Provider Business Practice Location Address
First Line	:	2226 SARNO RD STE 111
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32935-3087
Country	:	US
Telephone Number	:	321-751-6390
Fax Number	:	321-751-6389

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. AL O'CONNELL
Credential	:
Telephone Number	:	321-725-4500

Provider Enumeration Date	:	12/01/2009
Last Update Date	:	12/01/2009

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