Provider Demographics
NPI:1255917530
Name:BRADY, CASEY (RADT)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:BRADY
Suffix:
Gender:M
Credentials:RADT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:527 S ARCHER ST
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-2421
Mailing Address - Country:US
Mailing Address - Phone:714-299-1729
Mailing Address - Fax:
Practice Address - Street 1:527 S ARCHER ST
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-2421
Practice Address - Country:US
Practice Address - Phone:714-299-1729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-18
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility