Healthcare Provider Details

I. General information

NPI: 1629878947
Provider Name (Legal Business Name): MRS. BRIA PETE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2025
Last Update Date: 03/17/2025
Certification Date: 03/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3014 GREEN ACRES DR APT 11
YOUNGSTOWN OH
44505-2081
US

IV. Provider business mailing address

3014 GREEN ACRES DR APT 11
YOUNGSTOWN OH
44505-2081
US

V. Phone/Fax

Practice location:
  • Phone: 234-313-4337
  • Fax:
Mailing address:
  • Phone: 234-313-4337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: