Provider Demographics
NPI:1629364864
Name:BRADLEY'S HOME HEALTH CARE CENTER
Entity Type:Organization
Organization Name:BRADLEY'S HOME HEALTH CARE CENTER
Other - Org Name:BRADLEY'S INFUSION SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:W
Authorized Official - Last Name:BRADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-383-9516
Mailing Address - Street 1:5208 CHARLOTTE PIKE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37209-3321
Mailing Address - Country:US
Mailing Address - Phone:615-383-9516
Mailing Address - Fax:615-279-1347
Practice Address - Street 1:5208 CHARLOTTE AVENUE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37209-3321
Practice Address - Country:US
Practice Address - Phone:615-383-9516
Practice Address - Fax:615-279-1347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-27
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN44374773336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0558170001Medicare NSC