Provider Demographics
NPI:1114937760
Name:ARC BRADENTON HC INC
Entity Type:Organization
Organization Name:ARC BRADENTON HC INC
Other - Org Name:FREEDOM VILLAGE BRADENTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-221-2250
Mailing Address - Street 1:6501 17TH AVE W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34209-7858
Mailing Address - Country:US
Mailing Address - Phone:941-798-8000
Mailing Address - Fax:
Practice Address - Street 1:6501 17TH AVE W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209-7858
Practice Address - Country:US
Practice Address - Phone:941-798-8000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL105655Medicare Oscar/Certification