Provider Demographics
NPI:1619011269
Name:THE BRADLEY CENTER, INC.
Entity Type:Organization
Organization Name:THE BRADLEY CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:RENE
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-788-8219
Mailing Address - Street 1:5180 CAMPBELLS RUN ROAD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15205-9731
Mailing Address - Country:US
Mailing Address - Phone:412-788-8219
Mailing Address - Fax:412-788-8215
Practice Address - Street 1:5180 CAMPBELLS RUN RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15205-9731
Practice Address - Country:US
Practice Address - Phone:412-788-8219
Practice Address - Fax:412-809-8200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA401010322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100728156Medicaid