MEDICARE: HOME HEALTH AGENCY- BREVARD, LLC

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	299992050	FL

General Provider Information

NPI Number	:	1518914555
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOME HEALTH AGENCY- BREVARD, LLC

Provider Business Mailing Address
First Line	:	720 W OAK ST
Second Line	:	SUITE 303
City	:	KISSIMMEE
State	:	FL
Zip	:	34741-4989
Country	:	US
Telephone Number	:	407-933-1400
Fax Number	:	407-933-1450

Provider Business Practice Location Address
First Line	:	720 W OAK ST
Second Line	:	SUITE 303
City	:	KISSIMMEE
State	:	FL
Zip	:	34741-4989
Country	:	US
Telephone Number	:	407-933-1400
Fax Number	:	407-933-1450

Authorized Official
Title or Position	:	REGULATORY AFFAIRS
Name	:	MS. ROBIN COHEN
Credential	:
Telephone Number	:	954-707-5880

Provider Enumeration Date	:	05/27/2006
Last Update Date	:	12/07/2011

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