Provider Demographics
NPI:1427315480
Name:HOME AIDE OF BREVARD, INC. DBA HOME AIDE OF FLORIDA
Entity type:Organization
Organization Name:HOME AIDE OF BREVARD, INC. DBA HOME AIDE OF FLORIDA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:A
Authorized Official - Last Name:DOWTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-480-7369
Mailing Address - Street 1:4898 MILDRED CT
Mailing Address - Street 2:
Mailing Address - City:COCOA
Mailing Address - State:FL
Mailing Address - Zip Code:32927-3721
Mailing Address - Country:US
Mailing Address - Phone:321-480-7369
Mailing Address - Fax:321-256-9184
Practice Address - Street 1:4898 MILDRED CT
Practice Address - Street 2:
Practice Address - City:COCOA
Practice Address - State:FL
Practice Address - Zip Code:32927-3721
Practice Address - Country:US
Practice Address - Phone:321-480-7369
Practice Address - Fax:321-256-9184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-16
Last Update Date:2012-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL230265251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health