Provider Demographics
NPI:1649618588
Name:CT BRAVO, INC.
Entity type:Organization
Organization Name:CT BRAVO, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:COLIN
Authorized Official - Middle Name:T
Authorized Official - Last Name:RIORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:BA-MBA, HCP
Authorized Official - Phone:803-642-1919
Mailing Address - Street 1:2645 WHISKEY RD
Mailing Address - Street 2:THE SHOPPES AT BROOKHAVEN, SUITE 105
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29803-8075
Mailing Address - Country:US
Mailing Address - Phone:803-642-1919
Mailing Address - Fax:803-642-7071
Practice Address - Street 1:2645 WHISKEY RD
Practice Address - Street 2:THE SHOPPES AT BROOKHAVEN, SUITE 105
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29803-8075
Practice Address - Country:US
Practice Address - Phone:803-642-1919
Practice Address - Fax:803-642-7071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-13
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCHAS-0475332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment