Healthcare Provider Details

I. General information

NPI: 1104763655
Provider Name (Legal Business Name): BADDAZZLE CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5015 29TH AVE W
BRADENTON FL
34209-6119
US

IV. Provider business mailing address

5015 29TH AVE W
BRADENTON FL
34209-6119
US

V. Phone/Fax

Practice location:
  • Phone: 941-794-5558
  • Fax: 845-725-7744
Mailing address:
  • Phone: 941-794-5558
  • Fax: 845-725-7744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: BETTY GORDON
Title or Position: OWNER/ADMIN
Credential:
Phone: 941-794-5558