Buddy' S Place MG LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

11374 Issued in FL

Legal business name

BUDDY' S PLACE MG LLC

Practice address

5370 NW 172ND St
Miami Gardens, FL 33055-4062

Phone

(305) 318-6593

NPI assigned

Jul 4, 2011

Last updated

Jul 4, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Revilbray Revilla

Title

Owner

Phone

(305) 318-6593

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1309737600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1309737600000",
    "number": "1073800603",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5370 NW 172ND ST",
            "city": "MIAMI GARDENS",
            "state": "FL",
            "postal_code": "330554062",
            "telephone_number": "305-318-6593"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5370 NW 172ND ST",
            "city": "MIAMI GARDENS",
            "state": "FL",
            "postal_code": "330554062",
            "telephone_number": "305-318-6593"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BUDDY' S PLACE MG LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-07-04",
        "last_updated": "2011-07-04",
        "status": "A",
        "authorized_official_last_name": "REVILLA",
        "authorized_official_first_name": "REVILBRAY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "305-318-6593"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "FL",
            "license": "11374",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Assisted Living Facility in Miami Gardens, FL
• Providers in Miami Gardens, 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 Jul 4, 2011; 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.