Provider Demographics
NPI:1790114858
Name:THE COTTAGES OF BRADENTON
Entity Type:Organization
Organization Name:THE COTTAGES OF BRADENTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATELYNN
Authorized Official - Middle Name:DARLENE
Authorized Official - Last Name:HOLTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-245-6681
Mailing Address - Street 1:5700 24TH ST E
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34203-4940
Mailing Address - Country:US
Mailing Address - Phone:941-755-0443
Mailing Address - Fax:941-755-3994
Practice Address - Street 1:5700 24TH ST E
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34203-4940
Practice Address - Country:US
Practice Address - Phone:941-755-0443
Practice Address - Fax:941-755-3994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-08
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL7835310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001803700Medicaid