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NPI Code Detail

MEDICARE: BRADLEY ROYALE, INC.

MEDICARE: BRADLEY ROYALE, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1314000000XSkilled Nursing Facility0028712IL

General Provider Information

NPI Number : 1992792527
Entity Type Code : Organization
Provider Name (Legal Business Name) : BRADLEY ROYALE, INC.
Provider Business Mailing Address
First Line : 650 NORTH KINZIE AVENUE
Second Line :
City : BRADLEY
State : IL
Zip : 60915-1227
Country : US
Telephone Number : 815-933-1666
Fax Number : 815-933-9866
Provider Business Practice Location Address
First Line : 650 NORTH KINZIE AVENUE
Second Line :
City : BRADLEY
State : IL
Zip : 60915-1227
Country : US
Telephone Number : 815-933-1666
Fax Number : 815-933-9866
Authorized Official
Title or Position : ADMINISTRATOR
Name : PENNY VARNAVAS
Credential :
Telephone Number : 815-933-1666
Provider Enumeration Date : 09/29/2005
Last Update Date : 10/02/2008

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Directions to “BRADLEY ROYALE, INC. ” Practice Location

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