Healthcare Provider Details

I. General information

NPI: 1245143767
Provider Name (Legal Business Name): BRADDY MENTAL HEALTH AND ADDICTION SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11280 W BUCHANAN ST # A
AVONDALE AZ
85323-6824
US

IV. Provider business mailing address

11280 W BUCHANAN ST # A
AVONDALE AZ
85323-6824
US

V. Phone/Fax

Practice location:
  • Phone: 614-806-3683
  • Fax:
Mailing address:
  • Phone: 614-806-3683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JOHN W NJOROGE
Title or Position: NURSE PRACTITIONER
Credential: DNP
Phone: 614-806-3683