Provider Demographics
NPI:1003948654
Name:BRADBOURNE HEALTHCARE, INC.
Entity type:Organization
Organization Name:BRADBOURNE HEALTHCARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:HAZEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DE CASTRO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:626-814-0200
Mailing Address - Street 1:1109 W SAN BERNARDINO RD STE 230
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91722-4166
Mailing Address - Country:US
Mailing Address - Phone:626-814-0200
Mailing Address - Fax:626-814-0225
Practice Address - Street 1:1109 W SAN BERNARDINO RD STE 230
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91722-4166
Practice Address - Country:US
Practice Address - Phone:626-814-0200
Practice Address - Fax:626-814-0225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA980001488251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHHA08217FMedicaid
CAHHA08217FMedicaid