Provider Demographics
NPI:1104946433
Name:ROSA BRADLEY HOME FOR ADULTS
Entity type:Organization
Organization Name:ROSA BRADLEY HOME FOR ADULTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ZENORA
Authorized Official - Middle Name:D
Authorized Official - Last Name:GARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-758-1736
Mailing Address - Street 1:PO BOX 819
Mailing Address - Street 2:2215 N, MEMORIAL DRIVE
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27835-0819
Mailing Address - Country:US
Mailing Address - Phone:252-758-1736
Mailing Address - Fax:252-758-1736
Practice Address - Street 1:2215 NORTH MEMORIAL DRIVE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27835
Practice Address - Country:US
Practice Address - Phone:252-758-1736
Practice Address - Fax:252-758-1736
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL-074023310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility