Organization Active NPI

Community Access to Child Health of Brevard, Inc.

  • Case Management Agency
  • Rockledge, FL
National Provider Identifier
1053533596
Registry record updated Feb 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Case Management AgencyTaxonomy code 251B00000X
Legal business name
COMMUNITY ACCESS TO CHILD HEALTH OF BREVARD, INC.
Practice address
1264 US Highway 1 Ste 103
Rockledge, FL 32955-2746
Phone
(321) 634-3688
Fax
(321) 504-0955
NPI assigned
May 3, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 15, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Lisa Kay Gemmill
Title
HR Manager
Phone
(321) 634-3688

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Agency 251B00000X Primary

Addresses

Primary practice location

1264 US Highway 1 Ste 103
Rockledge, FL 32955-2746

Mailing address

1264 US Highway 1 Ste 103
Rockledge, FL 32955-2746
Phone (321) 634-3688

Other identifiers 1

IdentifierTypeStateIssuer
058384702MedicaidFL

Other names 1

  • CATCH of Brevard Early Steps Other name

National Provider Directory

National Provider Directory
Tax ID family
Community Access to Child Health of Brevard Inc5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

3000 N Wickham Rd
Melbourne, FL 32935

3000 N Wickham Rd
Ste 101
Melbourne, FL 32935

65 E Nasa Blvd
Ste 106A
Melbourne, FL 32901

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1178150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1644883200000",
    "number": "1053533596",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1264 US HIGHWAY 1 STE 103",
            "city": "ROCKLEDGE",
            "state": "FL",
            "postal_code": "329552746",
            "telephone_number": "321-634-3688",
            "fax_number": "321-504-0955"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1264 US HIGHWAY 1 STE 103",
            "city": "ROCKLEDGE",
            "state": "FL",
            "postal_code": "329552746",
            "telephone_number": "321-634-3688",
            "fax_number": "321-504-0955"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY ACCESS TO CHILD HEALTH OF BREVARD, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-03",
        "last_updated": "2022-02-15",
        "certification_date": "2022-02-15",
        "status": "A",
        "authorized_official_last_name": "GEMMILL",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "KAY",
        "authorized_official_title_or_position": "HR MANAGER",
        "authorized_official_telephone_number": "321-634-3688"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "058384702",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CATCH of Brevard Early Steps",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "CATCH of Brevard Early Steps",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Rockledge, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.