Provider Demographics
NPI:1174795454
Name:BREVARD ALZHEIMER'S FOUNDATION, INC.
Entity type:Organization
Organization Name:BREVARD ALZHEIMER'S FOUNDATION, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:VICTOR
Authorized Official - Last Name:TIMMERMANN
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:321-253-4430
Mailing Address - Street 1:4676 N WICKHAM RD
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-7103
Mailing Address - Country:US
Mailing Address - Phone:321-253-4430
Mailing Address - Fax:321-253-1993
Practice Address - Street 1:4676 N WICKHAM RD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-7103
Practice Address - Country:US
Practice Address - Phone:321-253-4430
Practice Address - Fax:321-757-6971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-27
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010751300Medicaid
FL015080100Medicaid