Healthcare Provider Details

I. General information

NPI: 1255048401
Provider Name (Legal Business Name): BRADLEY ESTATES NURSING AND REHAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2022
Last Update Date: 10/27/2022
Certification Date: 10/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6735 W BRADLEY RD
MILWAUKEE WI
53223-3325
US

IV. Provider business mailing address

20876 SONRISA WAY
BOCA RATON FL
33433-1745
US

V. Phone/Fax

Practice location:
  • Phone: 414-354-3300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: JACOB JEIDEL
Title or Position: MANAGER
Credential:
Phone: 917-750-5089