Provider Demographics
NPI:1407885569
Name:BRADFORD COUNTY COMMISSIONERS
Entity Type:Organization
Organization Name:BRADFORD COUNTY COMMISSIONERS
Other - Org Name:BRADFORD COUNTY MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LOUANN
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:570-297-4111
Mailing Address - Street 1:15900 ROUTE 6
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:PA
Mailing Address - Zip Code:16947-9308
Mailing Address - Country:US
Mailing Address - Phone:570-297-4111
Mailing Address - Fax:570-297-0717
Practice Address - Street 1:15900 ROUTE 6
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:PA
Practice Address - Zip Code:16947-9308
Practice Address - Country:US
Practice Address - Phone:570-297-4111
Practice Address - Fax:570-297-0717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA022302314000000X
PA332BN1400X, 332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1000072830011Medicaid
PA4657400001Medicare NSC
PA1000072830011Medicaid