Provider Demographics
NPI:1144771247
Name:JAMES WILKES BRADHAM INC
Entity Type:Organization
Organization Name:JAMES WILKES BRADHAM INC
Other - Org Name:RIGHT AT HOME OF NORTH MS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:WILKES
Authorized Official - Last Name:BRADHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-621-9898
Mailing Address - Street 1:130 DESOTO AVE
Mailing Address - Street 2:SUITE 10
Mailing Address - City:CLARKSDALE
Mailing Address - State:MS
Mailing Address - Zip Code:38614-4439
Mailing Address - Country:US
Mailing Address - Phone:662-621-9898
Mailing Address - Fax:
Practice Address - Street 1:130 DESOTO AVE
Practice Address - Street 2:SUITE 10
Practice Address - City:CLARKSDALE
Practice Address - State:MS
Practice Address - Zip Code:38614-4439
Practice Address - Country:US
Practice Address - Phone:662-621-9898
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-24
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09423231Medicaid
MS07259241Medicaid