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NPI Code Detail

MEDICARE: COMMUNITY ACCESS TO CHILD HEALTH OF BREVARD, INC

MEDICARE: COMMUNITY ACCESS TO CHILD HEALTH OF BREVARD, 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
1163WC0400XCase Management Registered Nurse

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1962624403
Entity Type Code : Organization
Provider Name (Legal Business Name) : COMMUNITY ACCESS TO CHILD HEALTH OF BREVARD, INC
Provider Business Mailing Address
First Line : 1802 S FISKE BLVD STE 201
Second Line :
City : ROCKLEDGE
State : FL
Zip : 32955-3007
Country : US
Telephone Number : 321-634-3688
Fax Number :
Provider Business Practice Location Address
First Line : 1802 S FISKE BLVD STE 201
Second Line :
City : ROCKLEDGE
State : FL
Zip : 32955-3007
Country : US
Telephone Number : 321-634-3688
Fax Number :
Authorized Official
Title or Position : DIRECTOR
Name : SHELLI BUCKLEY
Credential :
Telephone Number : 321-634-3688
Provider Enumeration Date : 05/03/2007
Last Update Date : 02/05/2026

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