Provider Demographics
NPI:1790580983
Name:BRADFORD, AARON (QMHS BA)
Entity type:Individual
Prefix:
First Name:AARON
Middle Name:
Last Name:BRADFORD
Suffix:
Gender:M
Credentials:QMHS BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3156 STATE ROUTE 225
Mailing Address - Street 2:
Mailing Address - City:DIAMOND
Mailing Address - State:OH
Mailing Address - Zip Code:44412-9755
Mailing Address - Country:US
Mailing Address - Phone:330-604-6081
Mailing Address - Fax:
Practice Address - Street 1:771 N FREEDOM ST
Practice Address - Street 2:
Practice Address - City:RAVENNA
Practice Address - State:OH
Practice Address - Zip Code:44266-2470
Practice Address - Country:US
Practice Address - Phone:330-296-5552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-13
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator