Healthcare Provider Details

I. General information

NPI: 1871740449
Provider Name (Legal Business Name): BRADLEY HOME HEALTH CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2008
Last Update Date: 08/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4007 W CONCORDIA AVE 4007 WEST CONCORDIA AVE.
MILWAUKEE WI
53216-3623
US

IV. Provider business mailing address

4007 WEST CONCORDIA AVE 4007 WEST CONCORDIA AVE
MILWAUKEE WI
53216-3623
US

V. Phone/Fax

Practice location:
  • Phone: 414-873-0797
  • Fax: 414-873-0797
Mailing address:
  • Phone: 414-873-0797
  • Fax: 414-873-0797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number251E00000X
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. CHARLENE SMITH
Title or Position: OWNER
Credential: CEO
Phone: 414-873-0797