Evening Tide of Brevard, LLC

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

Legal business name

EVENING TIDE OF BREVARD, LLC

Practice address

100 N Orlando Ave
Cocoa Beach, FL 32931-2915

Phone

(321) 613-4569

Fax

(321) 613-0217

NPI assigned

Apr 1, 2016

Organization subpart

No

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

Authorized official

Name

Mr. Steven Douglas Tracy, NA

Title

Executive Director

Phone

(435) 760-4091

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1459468800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1459468800000",
    "number": "1184087694",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 N ORLANDO AVE",
            "city": "COCOA BEACH",
            "state": "FL",
            "postal_code": "329312915",
            "telephone_number": "321-613-4569",
            "fax_number": "321-613-0217"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 N ORLANDO AVE",
            "city": "COCOA BEACH",
            "state": "FL",
            "postal_code": "329312915",
            "telephone_number": "321-613-4569",
            "fax_number": "321-613-0217"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVENING TIDE OF BREVARD, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-01",
        "last_updated": "2016-04-01",
        "status": "A",
        "authorized_official_last_name": "TRACY",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_middle_name": "DOUGLAS",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "435-760-4091",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "NA"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dawn O Eckhoff, ARNP
• James Curtis Elmer, MD
• Erin J. Kahlon D.D.S. P.a.
• Kitty A. Evans, MH
• Stephanie Evans, MD
• Eric Wesley Fadely, MA MA
• Family and Pediatric Clinic
• Family and Pediatric Clinic
• Samir H Faris, MD
• Martha Kinman Fay, MSW CMHP

• Home Health Agency in Cocoa Beach, FL
• Providers in Cocoa Beach, FL by specialty
• Home Health Agency in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2016; 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.