Provider Demographics
NPI:1588170468
Name:BRADY ASSISTED LIVING LLC
Entity type:Organization
Organization Name:BRADY ASSISTED LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MONETTE
Authorized Official - Middle Name:BROWN
Authorized Official - Last Name:BRADY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-964-4105
Mailing Address - Street 1:PO BOX 4462
Mailing Address - Street 2:
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27204-4462
Mailing Address - Country:US
Mailing Address - Phone:336-964-4105
Mailing Address - Fax:
Practice Address - Street 1:612 E PRESNELL ST
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-4817
Practice Address - Country:US
Practice Address - Phone:336-512-4866
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-14
Last Update Date:2017-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities