MEDICARE: BRITO'S HOME 3 LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164062600
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRITO'S HOME 3 LLC

Provider Business Mailing Address
First Line	:	19059 NW 77TH PL
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33015-5257
Country	:	US
Telephone Number	:	786-565-9090
Fax Number	:	786-320-6165

Provider Business Practice Location Address
First Line	:	19059 NW 77TH PL
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33015-5257
Country	:	US
Telephone Number	:	786-565-9090
Fax Number	:	786-320-6165

Authorized Official
Title or Position	:	OWNER/ADMIN.
Name	:	VIRGINIA BRITO
Credential	:
Telephone Number	:	786-853-5569

Provider Enumeration Date	:	01/13/2020
Last Update Date	:	01/13/2020

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