MEDICARE: BRADFORD ASSOCIATES NC LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency	5580	NC

General Provider Information

NPI Number	:	1114268844
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRADFORD ASSOCIATES NC LLC

Provider Business Mailing Address
First Line	:	250 MAGNOLIA SQUARE CT
Second Line	:
City	:	ABERDEEN
State	:	NC
Zip	:	28315-2226
Country	:	US
Telephone Number	:	910-944-0938
Fax Number	:	910-944-0940

Provider Business Practice Location Address
First Line	:	250 MAGNOLIA SQUARE CT
Second Line	:
City	:	ABERDEEN
State	:	NC
Zip	:	28315-2226
Country	:	US
Telephone Number	:	910-944-0938
Fax Number	:	910-944-0940

Authorized Official
Title or Position	:	SOLE PROPRIETOR
Name	:	BEATRICE ELLISON
Credential	:
Telephone Number	:	910-944-0938

Provider Enumeration Date	:	03/05/2013
Last Update Date	:	09/23/2025

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