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General NPI Number Information
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NPI Number | 1053312165
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Entity Type | Organization
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Legal Business Name | BRADENTON COUNCIL ON AGING LLC
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Dates
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Enumeration Date | 08/10/2005
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Last Update Date | 10/13/2009
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Provider Practice Location Address
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Address Line | 105 15TH ST E
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City | BRADENTON
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State | FL
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Zip | 34208-1337
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Country | US
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Telephone | 941-750-9691
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Fax | 941-750-9554
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Provider Business Mailing Address
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Address Line | 1311 SW 16TH ST
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City | GAINESVILLE
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State | FL
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Zip | 32608-1128
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Country | US
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Telephone | 352-376-8821
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Fax | 352-376-3654
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | MR. JAMES W ECKLOF JR.
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Credential |
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Telephone | 352-376-8821
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | AL8659
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License Number State | FL
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