Provider Demographics
NPI:1639931199
Name:BRADLY'S HOUSES, LLC
Entity Type:Organization
Organization Name:BRADLY'S HOUSES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-361-7808
Mailing Address - Street 1:540 MAIN ST STE 112
Mailing Address - Street 2:
Mailing Address - City:DELTA
Mailing Address - State:CO
Mailing Address - Zip Code:81416-1834
Mailing Address - Country:US
Mailing Address - Phone:970-361-7808
Mailing Address - Fax:
Practice Address - Street 1:540 MAIN ST STE 112
Practice Address - Street 2:
Practice Address - City:DELTA
Practice Address - State:CO
Practice Address - Zip Code:81416-1834
Practice Address - Country:US
Practice Address - Phone:970-361-7808
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health