Provider Demographics
NPI:1215177761
Name:BUDDY'S PLACE,LLC
Entity Type:Organization
Organization Name:BUDDY'S PLACE,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JANNIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:LEBELLOT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-374-6040
Mailing Address - Street 1:229 LAUREL WAY
Mailing Address - Street 2:
Mailing Address - City:MIAMI SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33166-5138
Mailing Address - Country:US
Mailing Address - Phone:305-888-7165
Mailing Address - Fax:
Practice Address - Street 1:229 LAUREL WAY
Practice Address - Street 2:
Practice Address - City:MIAMI SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33166-5138
Practice Address - Country:US
Practice Address - Phone:305-888-7165
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-24
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility