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General NPI Number Information
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NPI Number | 1831707249
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Entity Type | Individual
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Provider Name | MR. BART JEROME BRADFORD
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Gender | Male
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Dates
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Enumeration Date | 07/22/2020
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Last Update Date | 07/22/2020
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Provider Practice Location Address
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Address Line | 401 LYNN ST STE A
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City | VIDALIA
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State | LA
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Zip | 71373-3806
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Country | US
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Telephone | 614-519-1615
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Fax |
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Provider Business Mailing Address
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Address Line | 421 MYRTLE ST
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City | VIDALIA
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State | LA
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Zip | 71373-3824
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Country | US
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Telephone | 614-519-1615
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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 | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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