Provider Demographics
NPI:1831345750
Name:BRT EXECUTIVES INC
Entity type:Organization
Organization Name:BRT EXECUTIVES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GINO
Authorized Official - Middle Name:
Authorized Official - Last Name:FINA
Authorized Official - Suffix:
Authorized Official - Credentials:CSA
Authorized Official - Phone:850-668-1164
Mailing Address - Street 1:1117 ROSEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32301-3627
Mailing Address - Country:US
Mailing Address - Phone:850-668-1164
Mailing Address - Fax:888-857-6448
Practice Address - Street 1:1117 ROSEWOOD DR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-3627
Practice Address - Country:US
Practice Address - Phone:850-668-1164
Practice Address - Fax:888-857-6448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-12
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAHCA 230573171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty