At Home of Brevard LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

9150 Issued in FL

Legal business name

AT HOME OF BREVARD LLC

Doing business as

Golden Wings Darrow ALF

Practice address

1351 Darrow Rd SW
Palm Bay, FL 32908-6248

Phone

(321) 676-6331

Fax

(321) 951-2118

NPI assigned

May 26, 2009

Organization subpart

No

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

Authorized official

Name

Michael Joseph Cullen

Title

Admiinistrator

Phone

(321) 676-6331

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Golden Wings Darrow ALF 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.

  • Assisted Living Facility
  • Palm Bay, FL
  • NPI 1629244629
  NPD tax ID

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

{
    "created_epoch": "1243296000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1243296000000",
    "number": "1730314311",
    "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": "1351 DARROW RD SW",
            "city": "PALM BAY",
            "state": "FL",
            "postal_code": "329086248",
            "telephone_number": "321-676-6331",
            "fax_number": "321-951-2118"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AT HOME OF BREVARD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-05-26",
        "last_updated": "2009-05-26",
        "status": "A",
        "authorized_official_last_name": "CULLEN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "JOSEPH",
        "authorized_official_title_or_position": "ADMIINISTRATOR",
        "authorized_official_telephone_number": "321-676-6331"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "FL",
            "license": "9150",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "684950400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Golden Wings Darrow ALF",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Muhammad Irfan Aslam, MD
• Christi Anna Asper, PA-C
• Assaf, Inc
• Wasim Michael Assaf, D.D.S.
• Associate Medical Management, Inc
• At Home of Brevard, LLC.
• Maria Paulina Atehortua
• Athena Ayurveda American Care & Wellness Inc
• Carol Atkinson, PHD, LMFT
• Atlantic Psychiatric Centers, Inc.

• 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 May 26, 2009; 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.