Provider Demographics
NPI:1275799454
Name:BRAVADAS INC.
Entity Type:Organization
Organization Name:BRAVADAS INC.
Other - Org Name:BRAVADAS WIG DESIGN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIR. OF OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:L
Authorized Official - Last Name:HOBBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-397-2524
Mailing Address - Street 1:515 N 87TH ST STE C
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-2830
Mailing Address - Country:US
Mailing Address - Phone:402-397-2524
Mailing Address - Fax:402-502-2061
Practice Address - Street 1:7928 W DODGE RD
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-3423
Practice Address - Country:US
Practice Address - Phone:402-397-6310
Practice Address - Fax:402-502-2061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-06
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE6649860001Medicare NSC