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General NPI Number Information
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NPI Number | 1609082478
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Entity Type | Organization
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Legal Business Name | BRADFORD HOME INC.
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Dates
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Enumeration Date | 05/16/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 59 BRADFORD DR
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City | SOUTH SAN FRANCISCO
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State | CA
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Zip | 94080-1129
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Country | US
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Telephone | 415-987-3401
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Fax |
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Provider Business Mailing Address
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Address Line | 59 BRADFORD DR
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City | SOUTH SAN FRANCISCO
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State | CA
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Zip | 94080-1129
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Country | US
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Telephone | 415-987-3401
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | ESTELITA EVANGELISTA
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Credential | RN
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Telephone | 415-987-3401
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number |
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License Number State | CA
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