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General NPI Number Information
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NPI Number | 1083028344
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Entity Type | Organization
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Legal Business Name | BRADLEY SELECTED HEALTHCARE LLC
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Dates
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Enumeration Date | 06/15/2014
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Last Update Date | 06/15/2014
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Provider Practice Location Address
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Address Line | 1360 S 5TH ST STE 312A
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City | SAINT CHARLES
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State | MO
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Zip | 63301-2449
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Country | US
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Telephone | 636-493-9962
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Fax | 636-753-3610
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Provider Business Mailing Address
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Address Line | 1360 S 5TH ST STE 312A
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City | SAINT CHARLES
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State | MO
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Zip | 63301-2449
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MELISSA BRADLEY
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Credential |
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Telephone | 314-368-6005
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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