At Home of Brevard, LLC.

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

10779 Issued in FL

Legal business name

AT HOME OF BREVARD, LLC.

Doing business as

Golden Wings Wendel

Practice address

3116 Wendel Rd SE
Palm Bay, FL 32909-8469

Phone

(321) 952-6623

Fax

(321) 952-6624

NPI assigned

Apr 30, 2008

Organization subpart

No

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

Authorized official

Name

Mr. Michael Joseph Cullen

Title

Administrator

Phone

(321) 676-6331

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Golden Wings Wendel Doing business as

Tax ID family

At Home of Brevard LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• At Home of Brevard LLC

  dba Golden Wings Darrow ALF

  • Assisted Living Facility
  • Palm Bay, FL
  • NPI 1730314311
  NPD tax ID

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

{
    "created_epoch": "1209513600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1209513600000",
    "number": "1629244629",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1351 DARROW RD SW",
            "city": "PALM BAY",
            "state": "FL",
            "postal_code": "329086248",
            "telephone_number": "321-676-6331",
            "fax_number": "321-951-2118"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3116 WENDEL RD SE",
            "city": "PALM BAY",
            "state": "FL",
            "postal_code": "329098469",
            "telephone_number": "321-952-6623",
            "fax_number": "321-952-6624"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AT HOME OF BREVARD, LLC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-30",
        "last_updated": "2008-04-30",
        "status": "A",
        "authorized_official_last_name": "CULLEN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "JOSEPH",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "321-676-6331",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "FL",
            "license": "10779",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6931120  00",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Golden Wings Wendel",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Christi Anna Asper, PA-C
• Assaf, Inc
• Wasim Michael Assaf, D.D.S.
• Associate Medical Management, Inc (Community Walk-In Clinic)
• At Home of Brevard LLC (Golden Wings Darrow ALF)
• Maria Paulina Atehortua
• Athena Ayurveda American Care & Wellness Inc (Jupiter Assisted Living LLC)
• Carol Atkinson, PHD, LMFT
• Atlantic Psychiatric Centers, Inc.
• Atm Amin DDS LLC

• Assisted Living Facility in Palm Bay, FL
• Providers in Palm Bay, FL by specialty
• Assisted Living Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2008; 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.