Provider Demographics
NPI:1841745585
Name:BRUVILDO-INC.
Entity Type:Organization
Organization Name:BRUVILDO-INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNERR
Authorized Official - Prefix:
Authorized Official - First Name:BRUNY
Authorized Official - Middle Name:
Authorized Official - Last Name:VILDORIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-650-1605
Mailing Address - Street 1:65 W MERRICK RD
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-5709
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:65 W MERRICK RD
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-5709
Practice Address - Country:US
Practice Address - Phone:516-812-5120
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-23
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health