Organization
BUDDY' S PLACE MG LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
REVILBRAY REVILLA (OWNER)
(305) 318-6593
Entity
Organization
Contact information
Practice address
5370 NW 172ND ST, MIAMI GARDENS, FL 33055-4062
(305) 318-6593
Mailing address
5370 NW 172ND ST, MIAMI GARDENS, FL 33055-4062
(305) 318-6593
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
11374
FL
Other
Enumeration date
07/04/2011
Last updated
07/04/2011
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