| Entity Name: | GREENBRIAR MANOR, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 22 Feb 2023 (2 years ago) |
| Document Number: | L23000095219 |
| FEI/EIN Number | 92-2685271 |
| Address: | 7555 131ST ST N, SEMINOLE, FL, 33776 |
| Mail Address: | 7555 131ST ST N, SEMINOLE, FL, 33776 |
| ZIP code: | 33776 |
| County: | Pinellas |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1447655626 | 2014-10-29 | 2020-05-13 | 7555 131ST ST, SEMINOLE, FL, 337764010, US | 7555 131ST ST, SEMINOLE, FL, 337764010, US | |||||||||||||||||||||||||
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| Phone | +1 727-398-0880 |
| Fax | 7273987117 |
Authorized person
| Name | MR. ROY SISON BRITO |
| Role | OWNER/ADMINISTRATOR |
| Phone | 7273980880 |
Taxonomy
| Taxonomy Code | 310400000X - Assisted Living Facility |
| License Number | AL6645 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 019776800 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| BRITO MICHELLE | Agent | 7555 131ST N, SEMINOLE, FL, 33776 |
| Name | Role | Address |
|---|---|---|
| BRITO ROY | Manager | 7555 131ST ST N, SEMINOLE, FL, 33776 |
| BRITO MICHELLE | Manager | 7555 131ST ST N, SEMINOLE, FL, 33776 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-10 |
| Florida Limited Liability | 2023-02-22 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
