10D2060093 CLIA NUMBER - CHILDRENS HEALTHCARE OF BREVARD LLC

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Laboratory Demographics

CLIA Number: 10D2060093

Facility Name: CHILDRENS HEALTHCARE OF BREVARD LLC

Facility Address:
2351 W EAU GALLIE BLVD STE 5
MELBOURNE, FL
ZIP 32935
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Facility Phone Number: 321 775-0477

Facility Type: Other - NP PEDIATRIC PRIMARY CARE

Certificate Type: Waiver

NPI Number: 1619445087

Taxonomy: 261Q00000X - Clinic/Center
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).

CLIA Record

Field Name	Field Value
CLIA Number	10D2060093
LAB Type	Other - NP PEDIATRIC PRIMARY CARE
Facility Name	CHILDRENS HEALTHCARE OF BREVARD LLC
Street	2351 W EAU GALLIE BLVD STE 5
City	MELBOURNE
State	FL
ZIP	32935
Phone	321 775-0477
CertificateType	4
CertificateEffectiveDate	6/6/2023
CertificateExpirationDate	6/5/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024