Provider Demographics
NPI:1235103029
Name:COASTAL HEALTH SYSTEMS OF BREVARD, INC.
Entity type:Organization
Organization Name:COASTAL HEALTH SYSTEMS OF BREVARD, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:BROOKE
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-633-7050
Mailing Address - Street 1:486 GUS HIPP BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-4800
Mailing Address - Country:US
Mailing Address - Phone:321-633-7050
Mailing Address - Fax:321-632-3005
Practice Address - Street 1:486 GUS HIPP BLVD
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-4800
Practice Address - Country:US
Practice Address - Phone:321-633-7050
Practice Address - Fax:321-632-3005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-16
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
341600000X
FL0025913416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL086957100Medicaid
FLA0608OtherAMBULANCE