NPIMap

Organization Active NPI

Brevard Alzheimer's Foundation Inc.

Doing business as Joe's Club

  • Adult Day Care Clinic/Center
  • Titusville, FL
National Provider Identifier
1518633569
Registry record updated Aug 19, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Day Care Clinic/CenterTaxonomy code 261QA0600X
Legal business name
BREVARD ALZHEIMER'S FOUNDATION INC.
Doing business as
Joe's Club
Practice address
830 S Park Ave
Titusville, FL 32780-4000
Phone
(321) 253-4430
Fax
(321) 253-1993
NPI assigned
Aug 19, 2021
Last updated
Aug 19, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 19, 2021

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

Authorized official

Name
Timothy Victor Timmemann
Title
Executive Director
Phone
(321) 253-4430

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Day Care Clinic/Center 261QA0600X Primary

Addresses

Primary practice location

830 S Park Ave
Titusville, FL 32780-4000

Mailing address

4676 N Wickham Rd
Melbourne, FL 32935-7103
Phone (321) 253-4430

Other identifiers 1

IdentifierTypeStateIssuer
104835401MedicaidFL

Other names 1

  • Joe's Club Doing business as

National Provider Directory

National Provider Directory
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.

NPI Registry JSON

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

{
    "created_epoch": "1629331200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1629331200000",
    "number": "1518633569",
    "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": "830 S PARK AVE",
            "city": "TITUSVILLE",
            "state": "FL",
            "postal_code": "327804000",
            "telephone_number": "321-253-4430",
            "fax_number": "321-253-1993"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BREVARD ALZHEIMER'S FOUNDATION INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-19",
        "last_updated": "2021-08-19",
        "certification_date": "2021-08-19",
        "status": "A",
        "authorized_official_last_name": "TIMMEMANN",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "VICTOR",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "321-253-4430"
    },
    "taxonomies": [
        {
            "code": "261QA0600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Day Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "104835401",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Joe's Club",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Titusville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2021; 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.