MEDICARE: MRS. BRIA PETE

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	376J00000X	Homemaker
2	385HR2060X	Child Intellectual and/or Developmental Disabilities Respite Care
3	261QA0600X	Adult Day Care Clinic/Center	OH

General Provider Information

NPI Number	:	1629878947
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BRIA PETE

Provider Business Mailing Address
First Line	:	3014 GREEN ACRES DR APT 11
Second Line	:
City	:	YOUNGSTOWN
State	:	OH
Zip	:	44505-2081
Country	:	US
Telephone Number	:	234-313-4337
Fax Number	:

Provider Business Practice Location Address
First Line	:	3014 GREEN ACRES DR APT 11
Second Line	:
City	:	YOUNGSTOWN
State	:	OH
Zip	:	44505-2081
Country	:	US
Telephone Number	:	234-313-4337
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/17/2025
Last Update Date	:	03/17/2025

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