Provider Demographics
NPI:1255842316
Name:BRADWELL DIVERSIFIED INC.
Entity Type:Organization
Organization Name:BRADWELL DIVERSIFIED INC.
Other - Org Name:HELPING HANDS PROVIDER SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GRACIELA
Authorized Official - Middle Name:A
Authorized Official - Last Name:BRADWELL
Authorized Official - Suffix:
Authorized Official - Credentials:SLP ASSISTANT
Authorized Official - Phone:956-792-4542
Mailing Address - Street 1:25673 BECKHAM RD
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78552-6356
Mailing Address - Country:US
Mailing Address - Phone:956-230-3301
Mailing Address - Fax:956-391-2825
Practice Address - Street 1:25673 BECKHAM RD
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78552-6356
Practice Address - Country:US
Practice Address - Phone:956-230-3301
Practice Address - Fax:956-391-2825
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRADWELL DIVERSIFIED INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-10-17
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX218312101Medicaid