Healthcare Provider Details

I. General information

NPI: 1457750135
Provider Name (Legal Business Name): BRADLEY IN HOME SERVICE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2014
Last Update Date: 03/26/2024
Certification Date: 03/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 N MERAMEC AVE STE 300
CLAYTON MO
63105-3750
US

IV. Provider business mailing address

141 N MERAMEC AVE STE 300
CLAYTON MO
63105-3750
US

V. Phone/Fax

Practice location:
  • Phone: 314-791-0109
  • Fax: 314-833-3058
Mailing address:
  • Phone: 314-791-0109
  • Fax: 314-833-3058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. MAIRIO RENWICK BRADLEY
Title or Position: OWNER
Credential:
Phone: 314-833-3050