Provider Demographics
NPI:1194081265
Name:BRADLEY HEALTH CARE, INC
Entity type:Organization
Organization Name:BRADLEY HEALTH CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:W
Authorized Official - Last Name:BRADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DPH
Authorized Official - Phone:615-383-2741
Mailing Address - Street 1:5206 CHARLOTTE PIKE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37209-3321
Mailing Address - Country:US
Mailing Address - Phone:615-383-2741
Mailing Address - Fax:615-298-3018
Practice Address - Street 1:4343 LEBANON PIKE
Practice Address - Street 2:SUITE 100
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-1221
Practice Address - Country:US
Practice Address - Phone:615-871-8217
Practice Address - Fax:615-871-8219
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRADLEY HOME HEALTH CARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-04-03
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000003420332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3543834Medicaid
0558170001Medicare PIN