Provider Demographics
NPI:1356593719
Name:BRADENTON OAKS, LLC
Entity type:Organization
Organization Name:BRADENTON OAKS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JONENE
Authorized Official - Middle Name:
Authorized Official - Last Name:EISCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-746-8108
Mailing Address - Street 1:1015 7TH AVE E
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208
Mailing Address - Country:US
Mailing Address - Phone:941-746-8108
Mailing Address - Fax:
Practice Address - Street 1:1015 7TH AVE E
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-2103
Practice Address - Country:US
Practice Address - Phone:941-746-8108
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-16
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL6662310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5026OtherUNIVERSAL HEALTH CARE