Provider Demographics
NPI:1417013897
Name:C & J BRADSHAW, LLC
Entity Type:Organization
Organization Name:C & J BRADSHAW, LLC
Other - Org Name:DMA HERITAGE MEADOWS LONG TERM CARE FACILITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:BRADSHAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-693-5918
Mailing Address - Street 1:6659 PRIVATE SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27565-7601
Mailing Address - Country:US
Mailing Address - Phone:919-693-5918
Mailing Address - Fax:
Practice Address - Street 1:6659 PRIVATE SCHOOL RD
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:NC
Practice Address - Zip Code:27565-7601
Practice Address - Country:US
Practice Address - Phone:919-693-5918
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHAL-039-001311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7803323Medicaid