Provider Demographics
NPI:1790740959
Name:BRADYVIEW MANOR LLC
Entity Type:Organization
Organization Name:BRADYVIEW MANOR LLC
Other - Org Name:BRADYVIEW MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:RENDOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-265-1164
Mailing Address - Street 1:PO BOX 240
Mailing Address - Street 2:
Mailing Address - City:BROCKWAY
Mailing Address - State:PA
Mailing Address - Zip Code:15824
Mailing Address - Country:US
Mailing Address - Phone:814-265-1164
Mailing Address - Fax:814-265-1377
Practice Address - Street 1:405 ROBINSON STREET
Practice Address - Street 2:
Practice Address - City:EAST BRADY
Practice Address - State:PA
Practice Address - Zip Code:16028
Practice Address - Country:US
Practice Address - Phone:724-526-3006
Practice Address - Fax:724-526-3775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA409150310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility