Healthcare Provider Details

I. General information

NPI: 1235033812
Provider Name (Legal Business Name): BRADFORD HOMES AGENCY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

384 ASPEN DR
DOVER OH
44622-9497
US

IV. Provider business mailing address

384 ASPEN DR
DOVER OH
44622-9497
US

V. Phone/Fax

Practice location:
  • Phone: 330-364-3033
  • Fax: 330-364-3033
Mailing address:
  • Phone: 330-364-3033
  • Fax: 330-364-3033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number StateNULL

VIII. Authorized Official

Name: KARENANN EDITH RADER
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 330-612-3605