Provider Demographics
NPI:1518365485
Name:BRADFORD OASIS
Entity Type:Organization
Organization Name:BRADFORD OASIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:EGBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-449-3076
Mailing Address - Street 1:92 COTTAGE ST
Mailing Address - Street 2:
Mailing Address - City:BRADFORD
Mailing Address - State:VT
Mailing Address - Zip Code:05033-8897
Mailing Address - Country:US
Mailing Address - Phone:802-449-3076
Mailing Address - Fax:
Practice Address - Street 1:92 COTTAGE ST
Practice Address - Street 2:
Practice Address - City:BRADFORD
Practice Address - State:VT
Practice Address - Zip Code:05033-8897
Practice Address - Country:US
Practice Address - Phone:802-449-3076
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-09
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0618311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home