Home at Last of Brevard,Inc.

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

Legal business name

HOME AT LAST OF BREVARD,INC.

Practice address

2333 Jupiter Blvd SW
Palm Bay, FL 32908-3416

Phone

(321) 508-4639

NPI assigned

Dec 13, 2010

Organization subpart

No

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

Authorized official

Name

Mr. Alvin Payne

Title

President

Phone

(321) 508-4639

Specialties & licenses 2

Addresses

Other identifiers 1

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

{
    "created_epoch": "1292198400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1292198400000",
    "number": "1508169657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2333 JUPITER BLVD SW",
            "city": "PALM BAY",
            "state": "FL",
            "postal_code": "329083416"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2333 JUPITER BLVD SW",
            "city": "PALM BAY",
            "state": "FL",
            "postal_code": "329083416",
            "telephone_number": "321-508-4639"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOME AT LAST OF BREVARD,INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-12-13",
        "last_updated": "2010-12-13",
        "status": "A",
        "authorized_official_last_name": "PAYNE",
        "authorized_official_first_name": "ALVIN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "321-508-4639",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "FL",
            "license": null,
            "primary": false
        },
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "FL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID WAIVER",
            "identifier": "674701996",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Palm Bay, FL
• Providers in Palm Bay, FL by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2010; 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.