MEDICARE: VNA SPACE COAST PRIVATE CARE, 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

General Provider Information

NPI Number	:	1396356119
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VNA SPACE COAST PRIVATE CARE, INC

Provider Business Mailing Address
First Line	:	958 20TH PL FL 2
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32960-6420
Country	:	US
Telephone Number	:	772-978-5585
Fax Number	:	772-978-5509

Provider Business Practice Location Address
First Line	:	391 COMMERCE PKWY STE 240-260
Second Line	:
City	:	ROCKLEDGE
State	:	FL
Zip	:	32955-4209
Country	:	US
Telephone Number	:	321-752-7550
Fax Number	:	321-417-3394

Authorized Official
Title or Position	:	VP OF CLINICAL OPERATIONS
Name	:	MR. JACQUELINE KEVILLE
Credential	:
Telephone Number	:	772-538-2504

Provider Enumeration Date	:	08/14/2020
Last Update Date	:	10/09/2025

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