Healthcare Provider Details

I. General information

NPI: 1215199336
Provider Name (Legal Business Name): BRALEY & THOMPSON, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2008
Last Update Date: 06/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 CLOTINE ST
SAINT ALBANS WV
25177-2509
US

IV. Provider business mailing address

9901 LINN STATION RD
LOUISVILLE KY
40223-3808
US

V. Phone/Fax

Practice location:
  • Phone: 304-720-1300
  • Fax:
Mailing address:
  • Phone: 800-866-0860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number StateWV

VIII. Authorized Official

Name: DEENA OMBRES
Title or Position: PRIVACY OFFICER
Credential:
Phone: 502-394-2387