Provider Demographics
NPI:1619742657
Name:BRAVERY NE FL LLC
Entity type:Organization
Organization Name:BRAVERY NE FL LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:CARREGAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-574-6405
Mailing Address - Street 1:1 NEWS PL STE A130
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-6509
Mailing Address - Country:US
Mailing Address - Phone:904-574-6405
Mailing Address - Fax:904-513-1082
Practice Address - Street 1:1 NEWS PL STE A130
Practice Address - Street 2:
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-6509
Practice Address - Country:US
Practice Address - Phone:904-574-6405
Practice Address - Fax:904-513-1082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-20
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health