Provider Demographics
NPI:1295514529
Name:BRADLEY, THERESA (OPERATIONS MANAGER)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:OPERATIONS MANAGER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 WILLOW LAWN DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-3427
Mailing Address - Country:US
Mailing Address - Phone:804-307-6615
Mailing Address - Fax:844-514-7677
Practice Address - Street 1:2801 PENNINGTON RD
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23294-4013
Practice Address - Country:US
Practice Address - Phone:804-307-6615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-26
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA310400000X, 101YP1600X, 171M00000X
171W00000X
VA1295514529172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No171W00000XOther Service ProvidersContractor
No172A00000XOther Service ProvidersDriver