Provider Demographics
NPI:1720529696
Name:SCHOOL DISTRICT-BREVARD COUNTY
Entity type:Organization
Organization Name:SCHOOL DISTRICT-BREVARD COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF ESE PROGRAM SUPPORT
Authorized Official - Prefix:
Authorized Official - First Name:DAWNA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOBERSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-633-1000
Mailing Address - Street 1:2700 JUDGE FRAN JAMIESON WAY
Mailing Address - Street 2:
Mailing Address - City:VIERA
Mailing Address - State:FL
Mailing Address - Zip Code:32940-6601
Mailing Address - Country:US
Mailing Address - Phone:321-633-1000
Mailing Address - Fax:
Practice Address - Street 1:2700 JUDGE FRAN JAMIESON WAY
Practice Address - Street 2:
Practice Address - City:VIERA
Practice Address - State:FL
Practice Address - Zip Code:32940-6601
Practice Address - Country:US
Practice Address - Phone:321-633-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-13
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008057801Medicaid
FL008057818Medicaid
FL008057812Medicaid
FL008057817Medicaid