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General NPI Number Information
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NPI Number | 1588170468
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Entity Type | Organization
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Legal Business Name | BRADY ASSISTED LIVING LLC
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Dates
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Enumeration Date | 12/14/2017
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Last Update Date | 12/14/2017
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Provider Practice Location Address
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Address Line | 612 E PRESNELL ST
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City | ASHEBORO
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State | NC
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Zip | 27203-4817
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Country | US
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Telephone | 336-512-4866
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 4462
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City | ASHEBORO
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State | NC
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Zip | 27204-4462
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Country | US
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Telephone | 336-964-4105
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MRS. MONETTE BROWN BRADY
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Credential |
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Telephone | 336-964-4105
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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