Provider Demographics
NPI:1245225960
Name:BRADENTON ENTERPRISE LLC
Entity Type:Organization
Organization Name:BRADENTON ENTERPRISE LLC
Other - Org Name:BRADEN RIVER CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:KRUGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-747-3706
Mailing Address - Street 1:2010 MANATEE AVE E
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-1560
Mailing Address - Country:US
Mailing Address - Phone:941-747-3706
Mailing Address - Fax:941-746-7785
Practice Address - Street 1:2010 MANATEE AVE E
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-1560
Practice Address - Country:US
Practice Address - Phone:941-747-3706
Practice Address - Fax:941-746-7785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSNF15320961314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL105045Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER