Brevard Alzheimer's Foundation, Inc.

Primary specialty

Adult Day Care Clinic/CenterTaxonomy code 261QA0600X

Legal business name

BREVARD ALZHEIMER'S FOUNDATION, INC.

Doing business as

Joe's Club
YourCare Brevard

Practice address

4676 N Wickham Rd
Melbourne, FL 32935-7103

Phone

(321) 253-4430

Fax

(321) 757-6971

NPI assigned

Mar 27, 2008

Organization subpart

No

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

Authorized official

Name

Mr. Timothy Victor Timmermann Jr.

Title

Executive Director

Phone

(321) 253-4430

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 2

• Joe's Club Doing business as
• YourCare Brevard Doing business as

Tax ID family

Brevard Alzheimer's Foundation Inc4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

• Brevard Alzheimer's Foundation Inc.

  dba Joe's Club

  • Adult Day Care Clinic/Center
  • Titusville, FL
  • NPI 1518633569
  NPD tax ID
• Brevard Alzheimer's Foundation Inc.

  • Adult Day Care Clinic/Center
  • Micco, FL
  • NPI 1952973109
  NPD tax ID
• Brevard Alzheimer's Foundation, Inc.

  dba Joe's Club

  • Non-emergency Medical Transport (VAN)
  • Melbourne, FL
  • NPI 1568887917
  NPD tax ID

Locations

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

{
    "created_epoch": "1206576000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658188800000",
    "number": "1174795454",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4676 N WICKHAM RD",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329357103",
            "telephone_number": "321-253-4430",
            "fax_number": "321-253-1993"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4676 N WICKHAM RD",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329357103",
            "telephone_number": "321-253-4430",
            "fax_number": "321-757-6971"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7951 Ron Beatty Blvd",
            "address_purpose": "LOCATION",
            "city": "Micco",
            "state": "FL",
            "postal_code": "329767468",
            "country_code": "US",
            "telephone_number": "321-253-4430",
            "fax_number": "321-243-1993",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "830 S Park Ave",
            "address_purpose": "LOCATION",
            "city": "Titusville",
            "state": "FL",
            "postal_code": "327804000",
            "country_code": "US",
            "telephone_number": "321-253-4430",
            "fax_number": "321-253-1993",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BREVARD ALZHEIMER'S FOUNDATION, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-27",
        "last_updated": "2022-07-19",
        "certification_date": "2022-07-19",
        "status": "A",
        "authorized_official_last_name": "TIMMERMANN",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "VICTOR",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "321-253-4430",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "261QA0600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Day Care",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "302R00000X",
            "taxonomy_group": "",
            "desc": "Health Maintenance Organization",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010751300",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "015080100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Joe's Club",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "YourCare Brevard",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "YourCare Brevard",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Holly Brennan, RD
• Robert F Brennan, MD
• Tara Jeanne Brennan, LCSW
• Anna Karin Brenner, PSY.D
• Brevard Accident & Work Injury Centers LLC
• Brevard Alzheimer's Foundation, Inc. (Joe's Club)
• Brevard Anesthesia Services PA
• Brevard Assisted Living LLC
• Brevard Behavioral Consultants, Inc
• Brevard Clinical Research Center, Inc.

• Adult Day Care Clinic/Center in Melbourne, FL
• Providers in Melbourne, FL by specialty
• Adult Day Care Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 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.