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General NPI Number Information
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NPI Number | 1396241576
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Entity Type | Individual
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Provider Name | BRADFORD RUSSELL NOLAND CDCA
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Gender | Male
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Dates
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Enumeration Date | 04/05/2018
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Last Update Date | 04/05/2018
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Provider Practice Location Address
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Address Line | 2775 STATE ROUTE 39
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City | SHELBY
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State | OH
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Zip | 44875-9466
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Country | US
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Telephone | 419-747-3322
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Fax |
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Provider Business Mailing Address
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Address Line | 2775 STATE ROUTE 39
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City | SHELBY
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State | OH
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Zip | 44875-9466
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Country | US
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Telephone | 419-747-3322
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3245S0500X
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Taxonomy Name | Children's Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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