Provider Demographics
NPI:1427113919
Name:BRADLEY-REID CORPORATION
Entity type:Organization
Organization Name:BRADLEY-REID CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO CASE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:BRADLEY
Authorized Official - Last Name:REID
Authorized Official - Suffix:
Authorized Official - Credentials:MHA
Authorized Official - Phone:704-333-5686
Mailing Address - Street 1:715 E 5TH ST STE 216
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28202-3001
Mailing Address - Country:US
Mailing Address - Phone:704-333-5686
Mailing Address - Fax:704-376-1931
Practice Address - Street 1:715 E 5TH ST STE 216
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28202-3001
Practice Address - Country:US
Practice Address - Phone:704-333-5686
Practice Address - Fax:704-376-1931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2011-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8700417Medicaid