Provider Demographics
NPI:1073113148
Name:CHARLES P. BRADLEY'S CONSTANCE CARE
Entity Type:Organization
Organization Name:CHARLES P. BRADLEY'S CONSTANCE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:R
Authorized Official - Last Name:SOWERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-477-8689
Mailing Address - Street 1:776 N COURT ST
Mailing Address - Street 2:
Mailing Address - City:CIRCLEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43113-1262
Mailing Address - Country:US
Mailing Address - Phone:740-477-8689
Mailing Address - Fax:740-477-8693
Practice Address - Street 1:776 N COURT ST
Practice Address - Street 2:
Practice Address - City:CIRCLEVILLE
Practice Address - State:OH
Practice Address - Zip Code:43113-1262
Practice Address - Country:US
Practice Address - Phone:740-477-8689
Practice Address - Fax:740-477-8693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2304296Medicaid